LEARNING OBJECTIVE: Recognize policies and procedures pertaining to the Family Advocacy Program.

The purpose of the Family Advocacy Program is to identify, treat, and monitor Navy personnel engaging in spouse or child abuse/neglect (whether physical or psychological) and sexual abuse. The program, a responsibility of the Navy Military Personnel Command, is guided by SECNAVINST 1752.3 and, further, by BUMEDINST 6320.70. In each geographical location, a Family Advocacy Representative (FAR), usually a staff member of the Naval Hospital, manages the program. A basewide committee, composed of medical, line, chaplain, and Family Service Center personnel, reviews abuse cases and determines whether each case is established, suspected, or unfounded. Established cases are reported at the central registry at the Bureau of Medicine and Surgery, where service statistics are compiled and the future assignment of established abusers is monitored and controlled.

DRUG AND ALCOHOL ABUSE PREVENTION AND CONTROL PROGRAM

LEARNING OBJECTIVE: Recognize policies and procedures pertaining to the Drug and Alcohol Abuse Prevention and Control Program .

The Navy has established a "zero tolerance" standard for drug usage. Although prevention and punishment are still major components of the zero tolerance policy, the major emphasis has shifted to education and training. Routine after-care treatment of addiction is rarely offered to individuals found abusing drugs, and the most likely outcome of drug abuse is appropriate disciplinary action and separation from the service. Levels of alcohol-abuse treatment range from shipboard education programs to inpatient admission. Post-treatment consists of monitoring and support groups, both of which are crucial aspects of the 1-year after-care rehabilitation program.

All individuals with substance abuse problems- whether alcohol-or drug-related-are totally accountable for their actions and the consequences of them in accordance with the Uniform Code of Military Justice (UCMJ) and other relevant federal, state, and local laws. See OPNAVINST 5350.4, Drug and Alcohol Abuse Prevention and Control, and SECNAVINST 5300.28, Military Substance Abuse Prevention and Control, for additional information and guidance.

Drug and alcohol abuse is costly in terms of lost work hours and unnecessary administrative and judicial processing and is a critical drawdown on morale and esprit de corps. It undermines the very fiber of professional readiness, safety, discipline, judgment, and loyalty. It is not only the abuser who is affected, but the abuser's shipmates as well. "Zero tolerance" recognizes that drug and alcohol abuse is incompatible with the maintenance of high standards of performance, military discipline, and readiness, and is destructive of Navy efforts to instill pride and professionalism in its members.

PREVENTION
Prevention programs are an important aspect of military l i f e . PREVENT 2000 (Personal Responsibility and Values, Education and Training) is a program designed specifically for the younger Sailor. ADAMS (Alcohol and Drug Abuse, Managers and Supervisors) is required for E-5 and above.

Most commands have full-time or collateral-duty DAPAs, Drug and Alcohol Program Advisors, who provide the direct liaison between law enforcement, medical, the Family Services Center, and the commanding officer in all matters dealing with intervention, identification, and treatment. The DAPA coordinates on-site training, facilitates Alcohol Anonymous meetings, and provides referrals for outside intervention and inpatient treatment if indicated. Personnel can be identified to the DAPA through aberrant behavioral patterns, suspicious medical findings, and by self-referral to either medical or the chaplain's office.

CONTROL
Medical personnel become professionally involved in substance abuse programs when called upon to withdraw blood or urine from an individual suspected of drug or alcohol abuse. Few areas cause as much concern and confusion to healthcare providers as the question of when those bodily fluids may be lawfully extracted.

At the outset, a few basic facts must be discussed.

1. The healthcare provider should not undertake a fluid extraction procedure when to do so is medically contraindicated.

2. Refusal to perform an extraction in the face of lawful authority could subject the healthcare provider to charges of obstruction of justice or willful disobedience of an order.

3. The healthcare provider is not an arbiter of the law. (In other words, the admissibility of evidence derived from a blood or urine sample is not a matter for Medical Department personnel to decide.)

4. Common sense and cooperation with command and law enforcement officials should be the guideposts in every instance where extraction of bodily fluids is an issue.

The following are the circumstances where withdrawal of blood or urine from active duty military members is authorized:

Consensual withdrawal-If an individual expressly consents to an extraction of bodily fluids and there is a legitimate reason for the extraction, the healthcare provider may perform the procedure.

Valid medical purpose-Specimens may be obtained from an individual for a valid medical examination, provided the individual has expressly or implicitly consented to the examination.

Competence for duty examinations-The Competence for Duty Examination request form (NAVMED 6120/1) contains a block for the submitting authority to request laboratory yes"> analysis. See figures 15-1 and 15-2. The following procedures should be used in handling competence for duty requests.

-The command initiating the request should complete items 1 through 12 of the form. The individual submitting the request must have authority to make the request. Normally, this will be a commanding officer, executive officer, or command duty officer of the initiating command.

-After proper initiation of the request, the medical officer or other authorized healthcare provider will complete blocks 13 through 49 on the form.

-If the command has requested laboratory analysis, the patient should first be requested to give written consent to the procedure. If the patient will not give consent but will allow extraction, the sample should be taken. If the patient refuses consent and will physically resist extraction, the requesting command should be notified and no extraction attempted unless a search authorization is issued.