I 
111TH CONGRESS 
1ST SESSION H. R. 3420 
To improve and enhance substance use disorder programs for members of 
the Armed Forces, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 30, 2009 
Mr. KENNEDY (for himself, Mr. JONES, Mr. PIERLUISI, Ms. SCHAKOWSKY, 
Mr. LOEBSACK, Mr. BISHOP of New York, Mr. TONKO, and Mr. 
GRIJALVA) introduced the following bill; which was referred to the Com-
mittee on Armed Services 
A BILL 
To improve and enhance substance use disorder programs 
for members of the Armed Forces, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Supporting Uniformed 
Personnel by Providing Oversight and Relevant Treatment 
for Substance Use Disorders Act’’ or the ‘‘SUPPORT for 
Substance Use Disorders Act’’. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
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(1) The Armed Forces is comprised of more 
than 1,400,000 members in the regular components 
and more than 1,080,000 members in the Reserves. 
More than 1,800,000 members of the Armed Forces 
have been deployed in Operation Iraqi Freedom, Op-
eration Enduring Freedom, and the Global War on 
Terrorism since 2001. 
(2) Substance use disorders are chronic dis-
eases that can be prevented, treated, and managed 
effectively. Failure to prevent or treat these condi-
tions results in severe and widespread consequences, 
including increased risk of suicide, exacerbation of 
mental and physical health disorders, increased risk 
of domestic violence and family discord, and in-
creased risk of unemployment and homelessness. 
(3) According to the 2005 Department of De-
fense Survey of Health Related Behaviors Among 
Active Duty Personnel, 24 percent of the members 
of the Armed Forces surveyed reported symptoms of 
alcohol dependence and nearly 11 percent of the 
members surveyed reported use of an illicit drug. 
Misuse of controlled prescription drugs, particularly 
narcotic painkillers, is a significant and growing 
problem among members of the Armed Forces as 
well. 
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(4) Substance abuse disorders often co-occur 
with other health problems. According to the 2007 
Report of the Department of Defense Task Force on 
Mental Health, 17 percent of soldiers from brigade 
combat teams are at risk of developing clinically sig-
nificant symptoms of post-traumatic stress disorder, 
major depression, or anxiety after deployment, and 
an even higher percentage of such soldiers, 28 per-
cent, would experience symptoms based upon broad-
er screening criteria. The prevalence of post-trau-
matic stress disorder within a year of combat de-
ployment was estimated to range from 10 to 25 per-
cent. 
(5) According to the 2007 Report of the De-
partment of Defense Task Force on Mental Health, 
symptoms of disorders such as post-traumatic stress 
disorder often include complex disinhibitory behav-
iors such as self-medicating with alcohol, other medi-
cations, or illicit drugs in an attempt to return to 
‘‘normalcy’’. 
(6) According to the 2007 Report of the De-
partment of Defense Task Force on Mental Health, 
of the 686,306 veterans separated from active duty 
between 2002 and December 2006 who were eligible 
for care from the Department of Veterans Affairs, 
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229,015 (or 33 percent) accessed care at a Depart-
ment facility. Of those veterans who accessed such 
care since 2002, 83,889 (or 37 percent) were diag-
nosed with or were evaluated for a mental disorder, 
including post-traumatic stress disorder (39,243 or 
17 percent), nondependent abuse of drugs (33,099 
or 14 percent), and depressive disorder (27,023 or 
12 percent). 
(7) According to the 2007 Report of the De-
partment of Defense Task Force on Mental Health, 
20 percent of married soldiers planned to separate 
or divorce. 
(8) According to the 2007 Report of the De-
partment of Defense Task Force on Mental Health, 
relationship problems are the top risk factor for sui-
cide. Mental disorders, alcohol and substance use 
disorders, and significant stress are other significant 
risk factors for suicide. The National Violent Death 
Reporting System of the Centers for Disease Control 
and Prevention determined that, of a group of 
former or current military personnel who died by 
suicide in 2005, 17.2 percent had an alcohol problem 
and 7.7 percent had a problem with other sub-
stances. The suicide prevention action network 
(SPAN) reports a 20 percent increase in suicide 
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among members of the Armed Forces on active duty, 
89 suicides in 2007 with 32 deaths under investiga-
tion, and a rise of attempted suicides by soldiers by 
6 times higher than it was at the start of Operation 
Iraqi Freedom. 
(9) While some commands and facilities in the 
Armed Forces provide outstanding services for mem-
bers of the Armed Forces for substance use dis-
orders, the prevention, diagnosis, mitigation, treat-
ment, and management of, and research on, sub-
stance use disorders in members of the Armed 
Forces is inconsistent in availability, structure, and 
success among the various Armed Forces. 
SEC. 3. COMPREHENSIVE PLAN ON PREVENTION, DIAG-
NOSIS, MITIGATION, TREATMENT, AND MAN-
AGEMENT OF SUBSTANCE USE DISORDERS IN 
MEMBERS OF THE ARMED FORCES. 
(a) REVIEW AND ASSESSMENT OF CURRENT CAPA-
BILITIES.— 
(1) IN
GENERAL.—Not later than 180 days 
after the date of the enactment of this Act, the Sec-
retary of Defense shall, in consultation with the Sec-
retaries of the military departments and the Sec-
retary of Veterans Affairs, conduct a comprehensive 
review of the programs and activities of the Depart-
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ment of Defense for the prevention, diagnosis, miti-
gation, treatment, and management of, and research 
on, substance use disorders in members of the 
Armed Forces. 
(2) ELEMENTS.—The review conducted under 
paragraph (1) shall include, at a minimum, an as-
sessment of each of the following: 
(A) The current state and effectiveness of 
the programs of the Department of Defense 
and the military departments relating to the 
prevention, diagnosis, mitigation, treatment, 
and management of, and research on, substance 
use disorders in members of the Armed Forces. 
(B) The adequacy of the availability of and 
access to care for substance use disorders in 
military medical treatment facilities and under 
the TRICARE program. 
(C) The adequacy of oversight by the De-
partment of programs relating to the preven-
tion, diagnosis, mitigation, treatment, and man-
agement of substance use disorders in members 
of the Armed Forces. 
(D) The adequacy and appropriateness of 
current credentials and other requirements for 
healthcare professionals treating members of 
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the Armed Forces with substance use disorders, 
including an assessment of the advisability of 
adopting uniform credentials and requirements 
for such treatment for healthcare professionals 
who are members of organizations such as the 
Association 
for 
Addiction 
Professionals 
(NAADAC), the American Society of Addiction 
Medicine (ASAM), the American Psychiatric 
Association (APA), and the National Board for 
Certified Counselors (NBCC). 
(E) The advisable ratio of physician and 
non-physician care providers for substance use 
disorders to members of the Armed Forces with 
such disorders. 
(F) The adequacy and appropriateness of 
protocols for the diagnosis, treatment, and 
management of substance use disorders in 
members of the Armed Forces. 
(G) The adequacy of the availability of and 
access to care for substance use disorders for 
members of the reserve components of the 
Armed Forces when compared with the avail-
ability of and access to care for substance use 
disorders for members of the regular compo-
nents of the Armed Forces, including an identi-
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(A) set forth the findings and rec-
ommendations of the Secretary regarding each 
element of the review set forth in paragraph 
(2); 
(B) set forth relevant statistics on the fre-
quency of substance use disorders in members 
of the regular components of the Armed Forces, 
members of the reserve component of the 
Armed Forces, and dependents of such mem-
bers (including spouses and children); and 
(C) include such other findings and rec-
ommendations on improvements to the current 
capabilities of the Department of Defense for 
the prevention, diagnosis, mitigation, treatment, 
and management of, and research on, substance 
use disorders in members of the Armed Forces 
as the Secretary considers appropriate. 
(b) PLAN FOR IMPROVEMENT AND ENHANCEMENT 
OF PROGRAMS.— 
(1) PLAN REQUIRED.—Not later than 180 days 
after the date of the enactment of this Act, the Sec-
retary of Defense shall, in consultation with the Sec-
retaries of the military departments and the Sec-
retary of Veterans Affairs, submit to the congres-
sional defense committees a comprehensive plan for 
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the improvement and enhancement of the programs 
and activities of the Department of Defense for the 
prevention, diagnosis, mitigation, treatment, and 
management of, and research on, substance use dis-
orders in members of the Armed Forces and their 
dependent family members. 
(2) BASIS.—The comprehensive plan required 
by paragraph (1) shall take into account the fol-
lowing: 
(A) The results of the review and assess-
ment conducted under subsection (a). 
(B) Any preliminary results of the study 
required by section 4. 
(C) Similar initiatives of the Secretary of 
Veterans Affairs to expand and improve care 
for substance use disorders among veterans, in-
cluding the programs and activities conducted 
under title I of the Veterans’ Mental Health 
and Other Care Improvements Act of 2008 
(Public Law 110–387; 112 Stat. 4112). 
(3) COMPREHENSIVE STATEMENT OF POLICY.— 
The comprehensive plan required by paragraph (1) 
shall include a comprehensive statement of the policy 
of the Department of Defense regarding the preven-
tion, diagnosis, mitigation, treatment, and manage-
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ment of, and research on, substance use disorders in 
members of the Armed Forces and their dependent 
family members. 
(4) AVAILABILITY
OF
SERVICES
AND
TREAT-
MENT.—The comprehensive plan required by para-
graph (1) shall include mechanisms to ensure the 
availability to members of the Armed Forces and 
their dependent family members of services and 
treatment for substance use disorders, including, but 
not limited to, services and treatment as follows: 
(A) Screening for substance use disorder in 
all settings, including primary care settings. 
(B) Short-term motivational counseling 
services. 
(C) Marital and family counseling. 
(D) Inpatient, intensive outpatient, or 
other residential care services. 
(E) Private medical, psychiatric, and pro-
fessional counseling services. 
(F) Relapse prevention services. 
(G) Ongoing aftercare and outpatient 
counseling services. 
(H) Pharmacological treatments aimed at 
treating substance use disorders, including 
treating cravings for drugs and alcohol. 
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(I) Detoxification and stabilization serv-
ices. 
(J) Coordination with groups providing 
peer-to-peer counseling. 
(K) Such other services as the Secretary 
considers appropriate. 
(5) PREVENTION
AND
REDUCTION
OF
DIS-
ORDERS.—The comprehensive plan required by para-
graph (1) shall include mechanisms to facilitate the 
prevention and reduction of substance use disorders 
in members of the Armed Forces through science- 
based initiatives, including education programs, for 
members of the Armed Forces and their families. 
(6) SPECIFIC INSTRUCTIONS.—The comprehen-
sive plan required by paragraph (1) shall include 
each of the following: 
(A) SUBSTANCES OF ABUSE.—Instructions 
on the prevention, diagnosis, mitigation, treat-
ment, and management of substance use dis-
orders in members of the Armed Forces, includ-
ing the abuse of alcohol, illicit drugs, and non-
medical use and abuse of prescription drugs (in-
cluding addiction to prescription drugs that is 
an unintended consequence of otherwise re-
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quired and medically appropriate pain treat-
ment). 
(B) HEALTHCARE
PROFESSIONALS.—In-
structions on— 
(i) appropriate training of healthcare 
professionals in the prevention, screening, 
diagnosis, mitigation, treatment, and man-
agement of substance use disorders in 
members of the Armed Forces; 
(ii) appropriate staffing levels for 
healthcare professionals at military medical 
treatment facilities for the prevention, 
screening, diagnosis, mitigation, treatment, 
and management of substance use dis-
orders in members of the Armed Forces; 
and 
(iii) 
such 
uniform 
training 
and 
credentialing requirements for physician 
and non-physician healthcare professionals 
in the prevention, screening, diagnosis, 
mitigation, treatment, and management of 
substance use disorders in members of the 
Armed Forces as the Secretary considers 
appropriate. 
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(C) SERVICES
FOR
DEPENDENTS.—In-
structions on the availability of services for sub-
stance use disorders to military dependents (in-
cluding services for dependents suffering from 
their own substance use disorder and depend-
ents suffering because of the substance use dis-
order of a member of the Armed Forces), in-
cluding instructions on making such services 
available to such dependents to the maximum 
extent practicable. 
(D) PREVENTION
MATERIALS.—Instruc-
tions on the dissemination of materials regard-
ing substance abuse prevention, including, at a 
minimum, materials on the following: 
(i) The dangers of alcohol abuse. 
(ii) The risks of self-medication, and 
the potential co-occurrence of drug use or 
abuse with illnesses such as post-traumatic 
stress disorder. 
(iii) The risks associated with abuse 
of prescription medications and the signs 
of inadvertent addiction to prescription 
medications that may occur as a con-
sequence of otherwise prescribed treatment 
plans, as well as the need to properly se-
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cure and dispose of such substances to 
safeguard such substances from third par-
ties such as children. 
(iv) The risks of substance abuse 
faced by military dependents due to the 
stresses of having a spouse or parent de-
ployed, as well as other factors relating to 
substance abuse that are unique to mili-
tary families. 
(v) Strategies for prevention of drug 
and alcohol abuse among children of mili-
tary families, and suggestions for military 
parents on how to intervene and find help 
for a child with a substance use disorder. 
(E) DIFFERENTIATION
OF
DISCIPLINARY 
ACTION AND TREATMENT.—Instructions on the 
separation of disciplinary actions from preven-
tion and treatment of substance use disorders 
in members of the Armed Forces. 
(F) CONFIDENTIALITY.—Instructions on 
confidentiality for members of the Armed 
Forces in seeking or receiving services or treat-
ment for substance use disorders. 
(G) PARTICIPATION
OF
CHAIN
OF
COM-
MAND.—Instructions on appropriate consulta-
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tion, reference to, and involvement of the chain 
of command of members of the Armed Forces 
in matters relating to the diagnosis, treatment, 
and management of substance use disorders in 
such members. 
(H) CONSIDERATION
OF
GENDER.—In-
structions on gender specific requirements in 
the prevention, diagnosis, mitigation, treatment, 
and management of substance use disorders in 
members of the Armed Forces, including gender 
specific care and treatment requirements. 
(I) 
COORDINATION
WITH
OTHER 
HEALTHCARE INITIATIVES.—Instructions on the 
integration of efforts on the prevention, diag-
nosis, mitigation, treatment, and management 
of substance use disorders in members of the 
Armed Forces with efforts to address co-occur-
ring health care disorders (including post-trau-
matic stress disorder and depression) and sui-
cide prevention. 
(7) OTHER
ELEMENTS.—In addition to the 
matters specified in paragraph (3), the comprehen-
sive plan required by paragraph (1) shall include the 
following: 
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(A) LEAD AGENT.—The designation by the 
Assistant Secretary of Defense for Health Af-
fairs of a lead agent to coordinate implementa-
tion of the plan. 
(B) MILESTONES AND SCHEDULES.—Mile-
stones and schedules for the achievement of the 
goals of the plan, including goals relating to the 
following: 
(i) Enhanced education of members of 
the Armed Forces regarding substance use 
disorders. 
(ii) Enhanced and improved identi-
fication and diagnosis of substance use dis-
orders in members of the Armed Forces. 
(iii) Enhanced and improved access of 
members of the Armed Forces to services 
and treatment for and management of sub-
stance use disorders. 
(iv) Appropriate staffing of military 
medical treatment facilities and other fa-
cilities for the treatment of substance use 
disorders in members of the Armed Forces. 
(C) BEST PRACTICES.—The incorporation 
of evidence-based best practices utilized in cur-
rent military and civilian approaches to the pre-
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vention, diagnosis, mitigation, treatment, and 
management of substance use disorders. 
(D) AVAILABLE RESEARCH.—The incorpo-
ration of applicable results of available studies, 
research, and academic reviews on the preven-
tion, diagnosis, mitigation, treatment, and man-
agement of substance use disorders. 
(8) UPDATE
IN
LIGHT
OF
INDEPENDENT 
STUDY.—Upon the completion of the study required 
by section 4, the Secretary of Defense shall— 
(A) in consultation with the Secretaries of 
the military departments and the Secretary of 
the Department of Veterans Affairs, make such 
modifications and improvements to the com-
prehensive plan required by paragraph (1) as 
the Secretary of Defense considers appropriate 
in light of the findings and recommendations of 
the study; and 
(B) submit to the congressional defense 
committees a report setting forth the com-
prehensive plan as modified and improved 
under subparagraph (A). 
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SEC. 4. INDEPENDENT REPORT ON SUBSTANCE USE DIS-
ORDERS 
IN 
MEMBERS 
OF 
THE 
ARMED 
FORCES. 
(a) STUDY REQUIRED.—The Secretary of Defense 
shall provide for a study on substance use disorders in 
members of the Armed Forces to be conducted by the In-
stitute of Medicine of the National Academies of Sciences 
or such other independent entity as the Secretary shall 
select for purposes of the study. 
(b) ELEMENTS.—The study required by subsection 
(a) shall include a review and assessment of the following: 
(1) The current state and effectiveness of the 
programs of the Department of Defense and the 
military departments relating to the prevention, di-
agnosis, mitigation, treatment, and management of, 
and research on, substance use disorders in members 
of the Armed Forces. 
(2) The adequacy of the availability of and ac-
cess to care for substance use disorders in military 
medical 
treatment 
facilities 
and 
under 
the 
TRICARE program. 
(3) The adequacy of the oversight by the De-
partment of Defense of programs related to the pre-
vention, diagnosis, mitigation, treatment, and man-
agement of substance use disorders in members of 
the Armed Forces. 
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(4) The adequacy and appropriateness of cur-
rent credentials and other requirements for physi-
cian and non-physician healthcare professionals 
treating members of the Armed Forces with sub-
stance use disorders. 
(5) The advisable ratio of physician and non- 
physician care providers for substance use disorders 
to members of the Armed Forces with such dis-
orders. 
(6) The adequacy and appropriateness of proto-
cols for the diagnosis, treatment, and management 
of substance use disorders in members of the Armed 
Forces. 
(7) The adequacy of the availability of and ac-
cess to care for substance use disorders for members 
of the reserve components of the Armed Forces 
when compared with the availability of and access to 
care for substance use disorders for members of the 
regular components of the Armed Forces. 
(8) The adequacy of the prevention, diagnosis, 
mitigation, treatment, and management of substance 
use disorders in dependent family members of mem-
bers of the Armed Forces, whether such family 
members suffer from their own substance use dis-
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