What Prevention and Treatment of Substance Dependence Can Tell Us About Addressing Violent Extremism.

In this article, the authors examine similarities between violent extremism and substance dependence. They review evidence from psychology, neuroscience, sociology, and public health that suggests that there are similarities in violent extremism and substance dependence in terms of the underlying neural pathways, social and psychological causes, behavioral patterns, and opportunities for prevention and intervention.

Military Behavioral Health Staff Perspectives on Telehealth Following the Onset of the COVID-19 Pandemic.

The COVID-19 pandemic prompted sweeping changes to behavioral health care delivery in the Military Health System (MHS), which turned to telehealth to minimize disruptions and ensure continuity of care for service members. Four to seven months into the pandemic, MHS behavioral health staff at ten military treatment facilities shared their experiences using telehealth and their perspectives on its utility, barriers to its wider integration in the MHS, and concerns about its use in the post-pandemic future. Telehealth use was previously low across the MHS, but it increased dramatically with the onset of the pandemic. At the time they were interviewed, nearly all providers who treated service members with posttraumatic stress disorder, depression, or substance use disorders were using audio-only telehealth in some capacity. Although most were not using video telehealth, three-quarters expressed an openness to using it in the future. However, the widespread integration of telehealth in the MHS will need to include efforts to overcome technical and administrative barriers and to address provider concerns about telehealth modalities for behavioral health care delivery-for example, the need for clinical guidance on using telehealth with specific types of patients, and provider and patient orientation on using telehealth technology.

Behavioral Health and Service Use Among Civilian Wives of Service Members and Veterans: Evidence from the National Survey of Drug Use and Health.

In recent years, policymakers and members of the media have raised concerns regarding access to behavioral health care for service members and veterans of the U.S. military and their families. Particular concern has been raised regarding the availability and accessibility of care to individuals covered by the U.S. Department of Defense Military Health System and the Veterans Health Administration. In this study, researchers analyzed the National Study of Drug Use and Health to examine utilization of behavioral health care among current or former wives of service members and veterans who are covered by either TRICARE or CHAMP-VA. Three findings of interest emerged from the analysis. First, relative to the comparison group, military wives were more likely to receive behavioral health services, but this pattern was exclusively due to use of prescription psychiatric medications. No difference was found for specialty behavioral health treatment. Second, residing in rural areas was negatively associated with behavioral health care service use for both groups. Third, contrary to expectations, military wives who live more than 30 minutes from a military treatment facility were more likely than military wives who lived closer to receive prescription psychiatric mediations but not other types of behavioral health services.

Access to Behavioral Health Care for Geographically Remote Service Members and Dependents in the U.S.

With many service members now returning to the United States from the recent conflicts in Iraq and Afghanistan, concern over adequate access to behavioral health care (treatment for mental, behavioral, or addictive disorders) has risen. Yet data remain very sparse regarding how many service members (and their dependents) reside in locations remote from behavioral health providers, as well as the resulting effect on their access to and utilization of care. Little is also known about the effectiveness of existing policies and other efforts to improve access to services among this population. To help fill these gaps, a team of RAND researchers conducted a geospatial analysis using TRICARE and other data, finding that roughly 300,000 military service members and 1 million dependents are geographically distant from behavioral health care, and an analysis of claims data indicated that remoteness is associated with lower use of specialty behavioral health care. A review of existing policies and programs discovered guidelines for access to care, but no systematic monitoring of adherence to those guidelines, limiting their value. RAND researchers recommend implementing a geospatial data portal and monitoring system to track access to care in the military population and mark progress toward improvements in access to care. In addition, the RAND team highlighted two promising pathways for improving access to care among remote military populations: telehealth and collaborative care that integrates primary care with specialty behavioral care.