1. I n t e g r i t y - S e r v i c e - E x c e l l e n c e Headquarters U.S. Air Force 1 Culture of Responsible Choices (CoRC) MTF Toolkit for Implementation Insert your name here

2. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 2 Where the AF stands…why CoRC?

3. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 3 The Problem Impact of drug use and alcohol misuse Clear and present danger to the mission Reduces readiness Wastes critical resources Erodes our Core Values/the Culture of Airmen

4. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 4 DoD/Air Force Heavy Alcohol Use* Trend 2002 DoD Survey of Health Related Behaviors Among Military Personnel * > 5 drinks on the same occasion at least once a week in the past 30 days Increase from 1998

5. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 5 Heavy Alcohol Use* Past 30 Days, Ages 18–55 *standardized 2001 NHSDA Note: 18-25 yr estimate significantly different from civilian estimate at 95% confidence * > 5 drinks on the same occasion each week in the past 30 days

6. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 6 Total AF: Alcohol Related Events

7. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 7 Total AF: Underage Drinking

8. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 8 Substance Misuse: A Clear and Present Danger Must reduce Alcohol Related Events! 80+% ADAPT referrals not Abusing/Dependent on Alcohol Alcoholism cannot/should not be our sole focus! Alcohol misuse is involved in: 33% of suicides 57% sexual assaults 28.5% domestic violence cases 44% PMV accidents 33% of our members commit 81% of our ARIs (17-24 year olds)

9. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 9 AF Illicit Drug Use AD AF FY04 0.45% Drug Positives (1,572 total) Discharge 1500 Airmen a year b/c of drug positives $36-79k avg. cost to produce each trained Airman Demand Reduction (Detection and Deterrence) Detection is important to the mission But once caught, we lose an airman Deterrence is vital to the mission Effective prevention results in saving an airman Comprehensive approach to further reduce use

10. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 10 The best models for change…

11. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 11 Community Approach to Population Health Services 0% 100% Excellent Poor Prevention and Education Leadership Supports Health Behavior Change Installation Policies Enhance Health Primary Care Early Intervention Specialty Care Treatment of Disease Helping Agency Support (IDS) HEALTH POPULATION

12. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 12 Research Says…. Comprehensive community approach ideal: Leadership Driven, Environmental Change, Information, Early Identification and Intervention, Policy/Deterrence, & Alternative Activities Key: Identify those at of risk Population based screening/assessment Good evidence for brief interventions Tailored feedback (in-person and mailed), Brief Interventions, Primary Care, Web-based programs, etc… Based on SAMHSA and NIAAA recommendations for prevention and early intervention in youth & young adults

13. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 13 Culture change requires emphasis on prevention: Leadership sets the tone -Commanders program! Wide range of prevention efforts Broad community involvement Medics offer enhanced screening and early intervention Create prevention opportunities outside of MTF Should be responsibility (not morality) based Standardize elements & evaluation Implementation must be locally tailored/flexible Changing the Culture

14. 2. 2. INDIVIDUAL LEVEL 3.BASE COMMUNITY 4. LOCAL COMMUNITY 1. LEADERSHIP INTEGRATED 4-PRONGED COMMUNITY APPROACH

15. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 15 The Road from 0-0-1-3 to CoRC…..

16. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 16 0-0-1-3: Basics Science-based community program from F.E. Warren 0-0-1-3 is a slogan that is part of a larger program 0 underage drinking, 0 DUIs, 1 drink/hour, 3 drinks per sitting max Wing Commanders Program ADAPT is a team player--not the lead All installation IDS/CAIB members had a role Public Affairs, Security Forces, Services, Command Master Chief/First Sergeants, and Chaplains have particularly involved roles 4 core levels of change: Strong Leadership, Individual, Base, & Community

17. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 17 Prevention: 0-0-1-3 Results 68% 68% 64% 64% 93% 93%

18. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 18 0-0-1-3s Savings in Resources *68% decrease in alcohol related incidents 8% increase in available-for-duty rate (or 38 more airmen) 230 duty days not lost to Alcohol-Related Incidents *70% decrease in Article 15s CCs / Shirts with more time for mission / morale / welfare Contrary to popular myths, Services showed a profit! MWRF NIA increased $173K / Club profit of $13K *Comparison of First Quarter 2004 to First Quarter 2005

19. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 19 From F.E. Warren to AF Program March 05: Chief of Staff of the Air Force (CSAF) Task:Develop an AF plan & product based on 0-0-1-3 HQ AF Personnel (DP): primary POCs for CoRC Other functional groups are collaborators CoRC built from best of science and AF programs Launch Air Force wide in April 2006

20. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 20 CoRC: AF Functional Community Players Public Affairs Legal Security Forces Medical Treatment Facility Chaplains Mission Support/ Services Senior Leadership CC/1 st Sergeants

21. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 21 CSAF: Basics for CoRC Guiding principles Commanders program Responsible drinking vs. abstinence only Incident deterrence Attention to prevention: alcohol misuse and abuse Emphasize Common Airman Culture Program goals over first year (baseline year FY04) Decrease alcohol-related incidents (ARIs) by 25% - Underage drinking, DUIs, crimes, etc. - Reevaluate goal after year 1 Decrease confirmed drug positives by 25% Reevaluate goal after year 1 WORK HARD – PLAY SMART!

22. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 22 CoRC Basics 1. Leadership Driven Program: Message and support from top down 2. Individual Level Opportunities for Change Assessment/Screening of risk in all personnel Education/awareness Brief Interventions and treatment when needed Responsibility and commitment 3. Base Community Opportunities for Change Develop range of alternate activities Consistent and equitable detection/enforcement Media campaign promoting responsibility Monitor AF metrics/consider base specific metrics 4. Local Community Opportunities for Change Assess threat and availability of drugs and alcohol Develop coalition with community agencies

23. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 23 CoRC: Roles and Responsibilities HQ Personnel (DP): Deliver Concept of Operations Functional groups developed area specific Toolkits MTF role at the base level: Enhanced screening and early intervention Participation in outreach Serve as subject matter expert consultants to the CC

24. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 24 Surgeon Generals Toolkit: Bucket 1 Universal/Primary Prevention Population outreach: Screening population/surveillance Take temperature of risk on base Education and feedback at teachable moments

25. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 25 Selected/Secondary Prevention Targeted, individualized, non-anonymous alcohol and drug screening at Primary Care and Flight Medicine PHA: Everyone screened annually, feedback provided, and referred as needed Routine Care: Options for screening, brief intervention and referral as part of routine care Surgeon Generals Toolkit: Bucket 2

26. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 26 Targeted/Tertiary Prevention Screening, Assessment & Brief Intervention Designed for behavioral health outside of ADAPT Family Advocacy and Life Skills Support Centers Tools to identify and treat sub-clinical alcohol misuse Improved identification of substance use disorders Options for screening at each new intake Improved decision tree When to refer to ADAPT and when to incorporate into existing treatment plan Surgeon Generals Toolkit: Bucket 3

27. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 27 Subject Matter Consultation Guidance for ADAPT and DDR PMs about their role as CC consultants for CoRC implementation Booklet with core consultant competencies References and Resources Resources and opportunities for training Surgeon Generals Toolkit: Bucket 4

28. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 28 See Surgeon Generals Toolkit for Details about Each Bucket