Alcoholism

[PPCLI MCpl]

A little background:

I have recently been involved in assisting two members of my sub-unit with their drinking problems.   After these brave young lads voluntarily came forward to ask for help, I encountered a confusing process dealing with the CoC, MP's, the MO, the Padre, Bn Duty staff and a few nosey Med A's.   While all these pers meant well, I came to realize that we didn't have a standardized set of procedures to deal with such cases.   On both occasions, these soldiers' frustrated immediate supervisors ended up driving them to a civilian addictions foundation.   Both soldiers then got the help they needed and have since returned and are doing well.   I understand that different cases require different solutions, and that the situation will always dictate, but I believe that there should be some guidelines in place.

These are my questions:
 
1) What is the correct procedure for dealing with troops who come forward voluntarily and ask for help with their addictions?  

2) Who should, and should not, be getting involved in the problem? and

3) Does a soldier have the right to check themselves in to a civilian addictions program?


Any input would be most appreciated.

 

[Michael OLeary]

While such cases used to be dealt with principally by the chain of command in cooperation with the medical system, changes to the relationship between the two makes the medical system the lead agency in any cases where treatment is clearly warranted (unless there are clear disciplinary factors which must be settled, during which medical treatment may well continue under the MO's direction). First point of contact should be the MO, who can prescribe a rehabilitation program, or direct other courses of treatment.

 

[old medic]

Here are your references:

The Medical Service Instruction (MSI) probably contains most of your answers.

A-AD-D24-001/AG-001, Alcohol Misuse -A Guide for Supervisors in the Canadian Forces

CFAO 19-31 -- MISUSE OF ALCOHOL
http://www.admfincs.forces.gc.ca/admfincs/subjects/cfao/019-31_e.asp

PROCEDURE

6. Members who become concerned about their personal drinking habits are encouraged to seek assistance voluntarily. A member who initially seeks assistance from the CO, chaplain, social work officer, the base alcoholism counsellor (BAC), or other such person should be referred to the unit MO.
TREATMENT NOT REQUIRED

7. If the MO determines that the member who sought assistance voluntarily does not require treatment, all documentation will be placed in the CF 2034 (Medical Envelope). No documentation is placed on the member's personnel file.

TREATMENT REQUIRED

8. Where treatment is indicated, the MO signs Part 2 of Annex A, which the CO countersigns, directing the member to undertake treatment. The provisions of paragraphs 16 through 24 then apply. When a member volunteers for treatment and subsequent behaviour warrants administrative action (for example, Recorded Warning), the CO is not precluded from taking such action because member has "volunteered" for treatment. Appropriate documentation is then placed on the member's personnel file.

MSI CF 1200-101
http://www.forces.gc.ca/health/policies/medServiceInstructions/engraph/msi_cf_1200-101_e.asp

The CFMS will provide:

    * the chain of command with advice and assistance relating to the management of chemical dependencies and other addictions; and
    * treatment for members with alcoholism, other chemical dependencies, pathological gambling and other addictions.

Background

Through related policies and procedures encompassing drug control, misuse of alcohol, and treatment of alcoholism, CFMG provides advice and assistance to the chain of command in areas relating to the management of chemical dependencies and other addictions. Unit medical officers, Base/Wing Surgeons and BACs provide such advice and carry out, in concert with other helping professionals, treatment and follow-up regimens in the areas of chemical dependence and other addictions, including but not limited to pathological gambling.

Role of the BAC

The role of the BAC is to:

    * Assist the medical officer in the assessment and diagnosis of alcohol/drug abuse, chemical dependence, problematic or pathological gambling and other addictions;
    * Provide or supervise substance abuse interventions for those abusing, but not dependent on alcohol or other drugs;
    * Assist the medical officer with the provision of treatment/continuing care to those members diagnosed as chemically dependent or pathological gamblers;
    * Make/coordinate the referral of clients to outside CFMG-approved treatment resources, when necessary; and
    * Be an active member of the mental health clinic team.

Related:

CANFORGEN 092/02.
Medical Directive 4/92
CFMO 08-02
CFMO 29-21
CANFORGEN 026/00

Members should be dealing with the Unit/Base MO and BAC regarding any program.

<Edit: Just to clarify for those who won't read the links, BAC is Base Addictions Counselor>

 

[Chimo]

Congrats to the "immediate supervisors" that took action. I am surprised that they didn't know that the MO should have been the first POC. I am only making a comment not making an attack, I don't know the individuals or rank/experience levels. Well done on doing the right thing.

It sounds like a good point to bring up at your next unit's NCO PD training. 

 

[geo]

Hmm... something to add to the Troop leader's aide memoire.

 

[rosco]

I need an Administrative guru.

I am the AO for a member with Administrative Action pending for ‘Misuse of Alcohol.’  I have done a lot of research and I have found that this member’s C&P was not properly administered as per CFAO 19-31 (Misuse of Alcohol) and, CANFORGEN 092/02 (Clarification of CFAO 19-31).

In short, the mandatory Medical Referral (as required by the above references) was not conducted for the C&P.  The member is now looking at a ‘Recommendation for Release’ based on a violation of C&P.  The required Medical Referals were conducted for the IC, RW and Recomendation for Release but not the C&P.

My questions is; was the C&P valid and if it is not what is the consequences for the Release?

I have looked into the CFAOs, DAODs and QR&O.  As well as the ‘Grievance Board Decisions’ but I can find no precedent.  Does someone with more TI than me have any experience to share?

I would appreciate restraint regarding comments on this individual’s behaviours.  This is strictly an administrative query.

 

[Pusser]

You need to talk to your Command G1/N1/A1 organization.  There should be an officer there who is specifically responsible for this sort of thing.  It may have to be elevated to DGMC(?).  I've seen a number of cases where files were reviewed and "do-overs" were granted because of anomalies in the IC/RW/C&P process.  The bottom line is that the system cannot deviate from the Misuse of Alcohol flowchart.  If someone misses a step, you can't just blunder ahead.  You have to turn around, go back and then follow the right line.  If you don't do this, them member simply goes to the Human Rights Tribunal and gets reinstated with backpay.  If you don't want this to bite you later, you have to correct the previous mistakes and do it right. 

I was involved in a case years ago where a member was on his way out the door when I discovered a few errors in how his case had been handled.  I managed to convince the CO that we had to fix what had gone wrong.  The end result was that the member was allowed to stay in, he sobered up, his marriage came back from the brink of collapse and he went on to become a senior NCO and productive member of the CF.  I don't take credit for all of this because it was the member who had the biggest challenge ahead of him, but it does show that rehabilitation is possible, IF the system follows the correct steps.

 

[Occam]

Have you tried the people at DMCARM 5 (aka "Sex, Drugs & Rock 'n roll"), as the last para of the CANFORGEN suggests?

Additionally, this DWAN link will bring you to several documents related to Misuse of Alcohol.  The link for the aide-memoire contains the following:

In order to facilitate the administrative review process, unit must take the following actions:
- Take admin action every time there is a Misuse of alcohol (MoA).
- Send member for medical assessment after every incident related to alcohol and document that you have done so.
- Examine member’s Pers File for all applicable information concerning MoA.
- Assemble copies of all applicable info.
- Summarize all information and make a recommendation for either Release or Retention. Documented substantiation supporting the CO’s recommendation is required by DMCARM.
- Send all info to DMCARM 5-4

 

[rosco]

Pusser - Thanks for the reply.  That is what I thought.  The file is at DGMC and I put the ‘Administrative Error’ forefront in the member’s representation.  I am hoping this will buy one more chance for this individual to turn things around.

Occam – Thanks for the link.  I did find that aide-memoire and used it as a reference in the representation.  I appreciate the help. DMCARM was not too helpful.  They told me that the matter was a part of the Administrative Review and that I had to wait for that decision.  Fair enough I suppose.

My biggest question is, due to the error, what are the chances this member will be retained?  I am trying to anticipate the next bound which would involve a Redress of Grievance based on the ‘Administrative Error.’

 

[Pusser]

Frankly, retention is a bit of a crap shoot.  Much of it depends on Chain of Command support.  DMCARM will take the CO's recommendations very seriously.  Another thing to keep in mind is his overall performance.  A solid performer who gets in trouble when he drinks too much will be lookded at differently than an all round waste of rations who drinks too much.  Other factors include how much he/she embarrasses the organization or if whether their actions while drunk were over ther top. 

I know of another case where a junior officer (who was drunk) punched out a subordinate.  he was tried, found guilty, fined and then promoted!  Everyone swore up and down that the previous incident was out of character and that it would never happen again.  The next time it did hapen (when he was then a senior officer), you could feel the wind of the paper moving to administratively release him.

 

[Eye In The Sky]

Aside from the issue of if the C & P was administered properly, another thought comes to mind.

If the mb you are talking about wants to stay in the CF...and obviously has trouble with alcohol, I'd say one of the best things he/she can do at this point is get in contact with the Addictions folks at the mbr's CFHS location.  Seriously.

I'd say the CO will take note of that.  It might be "too little, too late"...it might not.  Either way, this person needs treatment and that is the place to go.

 

[McG]

DMCARM

DMCARM

There is no DMCARM.  DMCA it is.

My biggest question is, due to the error, what are the chances this member will be retained?

There are a lot of factors at play, and an administrative oversight is only one.  Without getting into the details of your case (and we should not get into those details here), you will only get vague speculation here.

 

[Occam]

There is no DMCARM.  DMCA it is.

Well, I'll be damned.  Just when you thought you had the organization nailed down after 20-odd years...

http://www.forces.gc.ca/site/commun/ml-fe/article-eng.asp?id=4347

I wonder how many person/years of work that renaming process took? 

 

[George Wallace]

It all comes with the broken links and "Common Look".

 

[PMedMoe]

It all comes with the broken links

Those broken links drive me batty!! 

 

[gunnars]

I am interested that a social worker was not involved. In my opinion, a social worker would be the best professional to advocate for the best method of treatment based on individual needs and desires. Addictions is an area of such fine tuned expertise that outside resources may be the best possible option to assist is successful outcomes. What led me to applying to the military was literally stumbling into addictions counseling in my profession that led me to be linked to the CF. I provided many a crash course on the variouus methods of treatment for the addiction at hand and I encouraged critical thinking on the behalf of the client and the superiors to determine which treatment would be best for the client and the circumstances. Like with opiate addictions, methadone treatment is controversial in the CF because methadone keeps the individual fuctionally high, is this the person you want to be holding a gun beside you? But methadone treatment is very successful in the civillian population.

Basically, I do not think that a set standard of practice can be established but it should be encouraged in the health professions to stay up to date on standards of best practice and basic screening methods (screening takes 5 minutes.... it simply determines if there could be a cause for concern)

Finally, congrats to the member to be proactive in their health!

 

[captloadie]

If the error was that he was not referred "this time" to the MO, you might need to investigate the results of previous referrals. If he has been through the program before, and was not successful for all three phases, it will be as previously stated, a crap shoot with DMCA. It is sad to say though that in this day and age, a CO (or his adjutant who is doing the paperwork), does know the process for issuing a C&P, especially for alcohol related issues. In the several cases I have been involved with, we always do a thorough review of a member's files before issuing C&P to ensure the member can be briefed on the specific consequences to him/her, and not just the standard "if you screw up on C&P your out on your a**". 

 

[clericalchronicals]

I'm kind of surprised to not see anything here about the new DAOD on Misuse of Alcohol.  Any thoughts?

 

[reccecrewman]

Just curious as I have zero knowledge on the subject of alcohol misuse from my career - if a member voluntarily comes forward and says "I have a bad drinking problem, can I get help?" Is that individual going to be on the receiving end of disciplinary action? Let's suppose his drinking has never interfered with his work performance, he just finds he spends his evenings after work whetting his whistle and wants to get treatment to stop the drinking BEFORE it turns into an issue at work. Or would this be a supervisory call? (ie - His immediate C o C likes or dislikes him, and this becomes an easy way to nail him to the wall)

 

[Eye In The Sky]

The CofC doesn't have to be involved at all.  Tell the mbr to go to the Base Hospital, and talk to a MO.  The correct bouncing of the ball should start from there.

Seriously.  This is a medical issue at this point.  The mbr could only expect the treatment he/she needs (and at the appropriate *level*) IF...IF...they are honest with the CF Health Svcs staff they speak to about the amount of/frequency of drinking they actually do.  As the mbr is looking to self-refer, I assume they are going in with the right mindset.  Honesty is the key.