Welcome to the 90th Space Wing’s Developing a Responsible Drinking Culture Focus Day

1. Welcome to the 90th Space Wing’s Developing a Responsible Drinking Culture Focus Day

2. Administrative Notes

3. Opening RemarksCOL EVAN J. HOAPILICommander, 90th Space Wing

4. ALCOHOL RELATED INCIDENTS Outside Inside Gate Clear & Present Danger There is Hope and Help Immediate implementation Wing backing Based on national research Integrated and comprehensive plan

5. Wing Goal: Create a responsible alcohol culture that promotes healthy, low-risk drinking behavior • 50% reduction in DUIs over each of the next two years • Reduce high-risk drinking and associated problem behaviors • Increase awareness and prevalence of low-risk vs. high-risk drinking

6. FRUSTRATION & AMBIVALENCE • It’s just the age… • You can’t stop them… • Underage will drink… • I did it at that age… • I’m old enough to serve my country…I should be old enough to drink! #1 Risk: Demoralized Leadership

7. ALCOHOL RELATED INCIDENTS • Annually Alcohol is Key Factor in: • Traffic fatalities 40% • Assaults 72% • Suicides 35-80% • Sexual assaults 52-90% • Murders 50-76% • Spouse or child Abuse 50-65% • Drowning 69%

8. DRINKING & DRIVING • Drunk Driving is the Most Common Violent Crime in America • More than 1.4 million arrests each year • One third are repeat offenders • Traffic Accidents are the Greatest Single Cause of Death for Every Age From 6-33 • 40% of all traffic fatalities are due to alcohol • 50% for age 18-24

9. BINGE DRINKING • Be the victim or aggressor in physical or sexual assault • Experience serious accidental injury • Get into trouble with police • Engage in dangerous driving • Have unprotected & unplanned sex • Damage property Binge Drinkers are up to 10 Times More Likely to:

10. DRINKING: US & F. E. WARREN US Data based on interview of 68,000; SAMHSA, Office of Applied Studies, “National Survey on Drug Use and Health”, 2002. FE Warren Data based on anonymous written survey of 414 active duty members, 2004.

11. DRINKING: US & F. E. WARREN (YOUNG ADULT) US Data based on interview of 68,000; SAMHSA, Office of Applied Studies, “National Survey on Drug Use and Health”, 2002. FE Warren Data based on anonymous written survey of 414 active duty members, 2004.

12. ALCOHOL RELATED INCIDENTS/1000:AF AND WARREN, 2003 Data source: Air Force ADAPT; rates per 1000, AF end strength 369, 879, FEW 3,300; includes all incidents referred for ADAPT evaluation.

13. FEW’S 2003 ALCOHOL RELATED INCIDENTS (ARIs) 133 Alcohol Related Incident Events: DUIs 38 (29) Drunk on Duty 5 UADs 70 Reported Sexual Assault 11 Assaults 24 Other 16 (selling to minors, public intoxication, etc.) Total ARIs by Type: 164 Average Age 19

14. FEW’s 2003 ARIs DUIs: 38 Incidents (29 AD, Civ Service, Dep) 11 were Underage Average Age is 24 Average # of Drinks 4.6 81% Over Age 21 29% were Underage

15. FEW’S 2003 ARI IMPACT Article 15s Issued 40 Estimated Total Forfeiture of Pay $13,909 Reduction in Rank 32 cases Relieved of Duty 449 days Confinement 30 days Restriction 595 days Extra Duty Given 612 days Down on PRP TBD Work Days Lost TBD Days in Casual/General Duty Status TBD LORs/LOCs 32

16. FEW’s 2004 ARIs 38 Alcohol Related Incident Events: DUIs 11 (10) Drunk on Duty 3 UADs 19 Reported Sexual Assault 0 Assaults 4 Other 24 (selling to minors, public intoxication, etc.) Total ARIs by Type: 62 Average Rank Category Amn

17. FEW DATA: DRINKING & HIGH RISK BEHAVIORS # High Risk Behaviors Number of Drinks Average number of self-reported High Risk Behaviors: DUI/riding with drunk driver, argue/fight with spouse, physical fight, thinking about suicide, unprotected sex, unwanted or forced sex, late or missed work due to drinking, or using other drugs within the last year. Data from survey of 414 FEW active duty members, 2004.

18. F. E. WARREN’S STRATEGY OVERVIEW • Based on National Research: • National Institute of Alcohol Abuse and Alcoholism, “A Call to Action: Changing the Culture of Drinking at US Colleges”, 2002 • National Academy of Sciences, “Reducing Underage Drinking: A Collective Responsibility”, 2003

19. INDIVIDUAL LEVEL • Pre-Screening • Post Incident • Treatment • Discipline COMMUNITY LEVEL BASE LEVEL RESPONSIBLEDRINKINGCULTUREIntegrated3-Pronged Approach • Collaboration • Responsible Alcohol Service • Disciplinary Control Board • Awareness • Education • Prevention • Intervention

20. National Research:Changing the Culture at U.S. CollegesPENNY NORTONCEOFACE: Truth & Clarity On Alcohol

21. BREAK

22. INDIVIDUAL LEVEL • Pre-Screening • Post Incident • Treatment • Discipline COMMUNITY LEVEL BASE LEVEL RESPONSIBLEDRINKINGCULTUREIntegrated3-Pronged Approach • Collaboration • Responsible Alcohol Service • Disciplinary Control Board • Awareness • Education • Prevention • Intervention

23. Individuals at High Riskand The Air Force ADAPT Program CAPT ALAN OGLE Chief, Life Skills Support Center ADAPT Program Manager

24. KEY POINTS • Drinking Behavior-A Matter of Degree • Substance Use Patterns • Early Identification of Problems • Mandatory Evaluation and Treatment • How to Use the ADAPT program

25. WHY YOUNG PEOPLE DRINK: • Many Reasons • Fun • Curiosity: “rite of passage” • Peers: “the thing to do…” • Psychological Purposes • To increase positive feelings • To decrease negative feelings

26. NO RISK LOWRISK MODERTATE RISK HIGH RISK & ILLNESS LEVELS OF DRINKING BEHAVIOR: A MATTER OF DEGREE • No Risk • Low Risk Drinking • Problem Drinking • Illegal/Underage • Alcohol Related Incidents (ARI) • Binge Drinking • Alcohol Abuse • Alcohol Dependence

27. BLOOD ALCOHOL CONCENTRATION (BAC) • 0.03% (1 drink/hour): relaxed, feeling of exhilaration • 0.06% (1-2 drinks/hour): feeling of warmth and relaxation, decrease of fine motor skills • 0.09% (2-3 drinks/hour): slowed reaction time, poor muscle control, slurred speech, wobbly legs • 0.12% (2-4 drinks/hour): clouded judgment, lessened inhibitions and self-restraint, impaired reasoning and ability to make logical decisions, well over the legal limit

28. BLOOD ALCOHOL CONCENTRATION (BAC) • 0.15% (3-5 drinks/hour): blurred vision, speech unclear, unsteady walking, impaired coordination, possible blackout • 0.18% (5-8 drinks/hour): behavior is totally impaired, trouble staying awake, numb • 0.30% (8-13 drinks/hour): drunken-stupor or deep sleep • 0.40% (11-15 drinks/hour): coma, probable death • 0.50% (14-18 drinks/hour): death

29. LOW RISK DRINKING • Low Risk Drinking is Our Goal • Drinking Perceptions and Norms • Keep a Person’s BAC Below .05

30. FEW DATA: DRINKING & HIGH RISK BEHAVIORS # High Risk Behaviors Number of Drinks Average number of self-reported High Risk Behaviors: DUI/riding with drunk driver, argue/fight with spouse, physical fight, thinking about suicide, unprotected sex, unwanted or forced sex, late or missed work due to drinking, or using other drugs within the last year. Data from survey of 414 FEW active duty members, 2004.

31. RESPONSIBLE DRINKING

32. Operationalizing the Wing Goal: Create a responsible alcohol culture that promotes healthy, low-risk drinking behavior FE Warren Data based on anonymous written survey of 414 active duty members, 2004.

33. NO RISK LOWRISK MODERTATE RISK HIGH RISK & ILLNESS THREE-PRONGED APPROACH:INDIVIDUALS AT HIGH RISK • Persons at Moderate or High Risk for Problem Drinking or Substance Use Disorder • Enter AF with Established Alcohol Use Disorders • Genetics and/or Environment • Poor Coping Skills or Judgment

34. IDENTIFYING PERSONS AT HIGH RISK SAMPLE AUDIT ITEMS 1. How often do you have a drink containing alcohol? 0 – Never or less 1 - Monthly 2 - 2 to 4 times per month 3 - 2 to 3 times per week 4 - 4 or more times per week 4. How often during the last year have you found that you were not able to stop drinking once you had started? 0 - Never 1 - Less than monthly 2 - Monthly 3 - Weekly 4 - Daily or almost daily 8. How often during the last year have you been unable to remember what happened the night before because you had been drinking? 0 - Never 1 - Less than monthly 2 - Monthly 3 - Weekly 4 - Daily or almost daily • Self-Identification • Behavior • Universal Screening • Alcohol Use Disorder Identification Test (AUDIT) • Administered to all incoming personnel (FTAC, Rightstart) • CC notified of scores 8 or higher, with recommendation for referral to ADAPT evaluation

35. MANDATORY EVALUATION AND TREATMENT • AFI 44-121 Alcohol and Drug Abuse Prevention and Treatment (ADAPT) Program • ADAPT is Part of the 90th Medical Group, Life Skills Support Center • Program Manager: Captain Alan Ogle • NCOIC: MSgt Jeffrey Randall, CADAC • 773-2998

36. ADAPT PRIMARY OBJECTIVES: • Promote readiness, health and wellness • Through prevention and treatment of substance abuse • Provide education and treatment • For individuals with substance abuse problems • Return patients to unrestricted duty status • Or assist them in transition to civilian life

37. HOW TO USE ADAPT: REFERRALS FOR EVALUATION • Self-Referral • Medical Referral • Commander Referral

38. COMMANDER REFERRAL: • AFI 44-121 3.8.1 • A Unit commander shall refer all service members for assessment when substance use is suspected to be a contributing factor in any incident • DUI, public intoxication, drunk and disorderly, spouse/child abuse and maltreatment, under-aged drinking, positive drug test, or when notified by medical personnel. • Refer Within 7 Days of Incident, ASAP for DUI

39. COMMAND REFERRAL PROCESS: • Unit Commander (or Designee) Completes ADAPT Referral Form Which Provides Important Information About the Member and the Incident • Commander Informs the Member of the Purpose of the Appointment, That it is Nonpunitive, and That They are to Report in Uniform for a Substance Abuse Evaluation

40. EVALUATION PROCESS: • ADAPT will Provide an Appointment Within 7 Days (or as Soon as Possible) • Patient Receives a Substance Use Evaluation • American Society of Addiction Medicine criteria • “Motivational Interviewing” combined with the AF Substance Use Assessment Tool (SUAT) • Based on the information provided by the patient and unit, patient is directed to education or treatment • Following the Evaluation, the Commander/First Sergeant will be Briefed on the Outcome

41. TOP REASONS FOR ADAPT REFERRAL IN 2003

42. 2003 COMMANDER REFERRAL PERFORMANCEMANDATORY WITHIN 7 DAYS OF INCIDENT Total 103 ADAPT referrals in 2003.

43. 2003 EVALUATION RESULTS: DIAGNOSIS

44. ADAPT SERVICES: EVALUATION AND EDUCATION • All Referrals Receive: • Initial diagnostic evaluations • 6-hour Substance Abuse Awareness Seminar • Didactics and interactive group discussion • Use of video and impaired driving goggles • Verification of training via pre/post tests SAAS Topics - Air Force and civilian standards regarding to substance use -Hazards of binge drinking - Individual responsibilities relating to substance use -Group / Family Dynamics of substance abuse - Air Force and civilian legal/administrative consequences -DUI/DWI education - Facts and statistics about alcohol -Drug abuse education - Physical and psychological effects of abuse -Values clarification - Potential impact on self, others, and the community -Healthy stress management - Biopsychosocial Model and disease concepts of addiction -Decision-making and goal setting skills

45. SUBSTANCE USE DISORDERS: • 305.00 Alcohol Abuse (31% College Students) • Recurrent, significant adverse consequences related to repeated alcohol use • Not addicted to alcohol • 303.90 Alcohol Dependence (15% General Population, Lifetime Rate) • Clinically significant impairment • Continued use despite serious negative consequence • Tolerance • With/Without Physiological Dependence

46. ADAPT SERVICES: TREATMENT • Diagnosed AD Members Receive: • Individualized treatment • If medically indicated, referral for off-base care • AA / NA meetings in the community • Intensive outpatient program (3-4 hours/day, 4 days/ week) • Inpatient hospitalization for detox (3-7 days) • Inpatient/Residential program (4-6 weeks) • Referral for Spiritual Counseling as Desired • Transitional Counseling

47. ADAPT SERVICES: TREATMENT AFI Requires: • Complete Abstinence from Alcohol (Duration Set by TT) • A Medical Profile (S4T-not Worldwide Qualified) • Treatment Team Meetings-Initial and Quarterly • Patient • Commander • First Sergeant • Supervisor • Counselor • ADAPT Program Manager • Flight Surgeon (Missileers only) • Others invited (spouse/close friend/relative)

48. PROGRAM COMPLETION: • Successful Completion of the ADAPT Treatment Program is Based on: • Meeting diagnostic criteria for “early full remission” • Progress toward other treatment goals • No longer requiring ADAPT program services for healthy living within AF standards • Realistic Time Frames for Treatment Range from 4 to 24 Months Depending Upon Severity, Motivation, and Progress

49. PROGRAM FAILURE: • “Program Failure” is Determined by a Pattern of: • Unacceptable behavior/unwillingness to live within AF standards regarding alcohol • Inability or unwillingness to comply with the treatment plan • Involvement in alcohol and/or drug related incidents after receiving initial treatment. • Military Members who Fail the ADAPT Program will be Recommended for Separation from AF

50. 2003 ADAPT PROGRAM OUTCOMES