This paper examines the Army Substance Abuse Program (ASAP), tracing its origins to 1971 legislation and its significant policy revisions in 2012. It outlines the program's organizational hierarchy, detailing the responsibilities and credentials of key roles including Installation/Garrison Commanders, Drug Testing Coordinators, and Unit Prevention Leaders. The paper then explores the theoretical foundation underlying the program — treating substance abuse as a disease rather than a criminal act — and reviews recent peer-reviewed research on gender disparities in treatment, racial and religious factors in rehabilitation, stigma as a barrier to care, and biomarker-based alcohol testing. Together, these threads demonstrate why ongoing education requirements for ASAP personnel remain essential to effective program implementation.
The Army Center for Substance Abuse Programs was first established in 1971 in response to legislation requiring the Secretary of Defense to identify, treat, and rehabilitate members of the U.S. military determined to be dependent upon alcohol or illicit drugs. Similar legislation followed to require the same standards for civilian employees of the military. The Army Substance Abuse Program (ASAP) is the result of this overall shift in policy during the era of the Vietnam Conflict, when addiction to or abuse of alcohol and other drugs by military personnel — very often as a comorbidity associated with post-traumatic stress disorder, but also as a disease in its own right — gained a much higher level of visibility among the general public. This was partly because of the attention drawn to drug use in that era by the so-called "counterculture."
Popular depictions of the Vietnam conflict — such as the Oscar-winning Oliver Stone drama Platoon — prominently feature soldiers abusing cannabis, alcohol, and other drugs in ways that would be unimaginable in cinematic depictions of World Wars One or Two, or the Korean conflict. Such depictions are also largely absent from most portrayals of the U.S. Civil War, despite the widespread use of cannabis and opium as medications during that conflict, in an era before governmental regulation of these substances. The high visibility of drug abuse by military personnel in the period following the 1960s is presumably what prompted the legislation that created the Army Substance Abuse Program. The overall trend during that period has been away from a criminal deviance paradigm regarding substance abuse, and more toward understanding substance abuse as a disease — and approaching it accordingly through education, prevention, and treatment.
For a little over four decades, the Army Substance Abuse Program has been implemented to treat the abuse of chemical substances as a disease meriting rehabilitation, rather than immediately regarding it as a criminal action requiring disciplinary sanction. All military and civilian employees of the Department of Defense are potential beneficiaries of the services provided by the Army Substance Abuse Program if they are determined to require rehabilitation for abuse of or dependency upon drugs.
However, the policies for the Army Substance Abuse Program underwent significant overhaul in 2012, likely as a result of the alarming finding that more than one in five active-duty Army personnel and more than one in four National Guard personnel tested positive for illicit drug use between 2009 and 2012 (Platteborze et al., 2014, p. 653). This may be indicative of a comorbidity with post-traumatic stress disorder, which was diagnosed at much higher rates in the wake of the Afghanistan and Iraq conflicts than in previous military history, Vietnam included. The difficulty, however, is that the relationship between the two — while a matter of widely accepted folklore regarding "self-medication" — has not been sufficiently documented by medicine to establish the precise connection between post-traumatic stress disorder and abuse of alcohol or drugs (Larson Wooton et al., 2012, p. 7).
Commanders within the Army Substance Abuse Program operate at the level of Installation or Garrison, making them responsible for the implementation of ASAP within their individual jurisdictions. The primary enumerated duties of an Installation or Garrison Commander are to establish a full unit with staff in order to ensure that the complete range of services guaranteed to personnel by ASAP are accessible and operational. Because ASAP mandates both military staff and trained counselors, the Installation or Garrison Commander oversees both elements of personnel within a single location to maximize efficient cooperation despite differences in background or military status.
The necessary staff under the direct jurisdiction of the Installation or Garrison Commander includes: one Alcohol and Drug Control Officer to liaise with the administration of the garrison or installation; one Prevention Coordinator in charge of prevention and education; one Employee Assistance Program Coordinator to work with civilian personnel; one Drug Testing Coordinator to oversee drug and alcohol testing; one Installation Breath Alcohol Technician who operates the breathalyzer equipment for alcohol intoxication tests; and one Risk Reduction Program Coordinator in charge of mandated risk reduction activities.
Beyond the appointment and supervision of this core staff, an Installation or Garrison Commander establishes an additional team or council focused on substance abuse and risk reduction, and serves as chair of this body. The council must include representatives from all sectors related to military life, including the chaplaincy, medical teams, the safety office, social workers, the provost marshal, and suicide prevention workers, among others. The Installation or Garrison Commander is then responsible for implementing all further policies related to drug and alcohol abuse, including reporting illegal activity — such as trafficking in illicit drugs or underage drinking — to the Criminal Investigation Division, and otherwise enforcing the military's official policies regarding the reduction of alcohol and drug abuse.
The revisions to ASAP mandated in 2012 added one further duty for the Installation or Garrison Commander: transmitting information regarding soldiers who test positive for drugs or alcohol to the first General Officer in the chain of command, with the assured legal assistance of a judge advocate or similar legal advisor, who then makes the retention decision regarding such soldiers. This is in accordance with the sweeping 2012 revisions to military policy for separation actions, which changed the approach and guidelines to favor rehabilitation over disciplinary action as the preferred tool for handling substance abuse. The implication for the Installation or Garrison Commander is significant: whoever holds this position is entrusted with gathering and submitting information and evidence that might potentially end a soldier's career entirely and result in criminal charges and penalties. Given the high documented levels of drug and alcohol abuse within the military, this role must not be taken lightly.
"Licensing requirements and military rank qualifications"
"Disease model versus criminal paradigm in ASAP"
"Peer-reviewed studies on gender, race, stigma, biomarkers"
"Paradigm shift from moral to medical model"
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