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 History of CoRC Dr. Milton H. Cambridge Demand Reduction Prevention and Outreach Coordinator

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 Overview Development of CoRC 2005 DOD Survey of Health-Related Behavior Alcohol-Related Incidents (ARIs) Drug Positives Comprehensive Substance Abuse Prevention Program (CSAPP)

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 Overview NIAAA 2002: A Call to Action: Chaging the Culture of Drinking at U.S. Colleges Institute of Medicine 2003: Reducing Underage Drinking: A Collective Responsibility F. E. Warren 0-0-1-3 Program CORONA Tasker CoRC: Fundamental Principles

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 Survey DOD Survey of Health Related Behaviors Among Military Personnel http://www.ha.osd.mil/special_reports/2005_Health_B ehaviors_Survey_1-07.pdf http://www.ha.osd.mil/special_reports/2005_Health_B ehaviors_Survey_1-07.pdf

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 Trends by Service 2005 DoD Survey of Health Related Behaviors Among Military Personnel Air ForceMarine Corps NavyArmy AdjustedUnadjusted

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 Trends in Alcohol-Related Negative Effects 2005 DoD Survey of Health Related Behaviors Among Military Personnel Serious ConsequencesProductivity Loss Air ForceMarine Corps NavyArmy

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 DoD Self-Reported Drug Use 2005 DoD Survey of Health Related Behaviors Among Military Personnel MarijuanaAnalgesics SteroidsAny Illicit Drug a Significant difference between 2002 and 2005

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 DoD Self-Reported Drug Use 2005 DoD Survey of Health Related Behaviors Among Military Personnel Significant increase from 2002

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 Air Force Alcohol Related Incidents (ARI)

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 2005 Air Force Alcohol Related Incidents (total = 6441) Note: Airmen under 21 account for only 9% of AF population

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 Total AF: Underage Drinking

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 Air Force: Percent Drug Positive

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 Air Force: Top 4 Drug Positives By Drug Class

14. 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 14 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

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 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 ARI’s (17-24 year olds)

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 FY06 Alcohol-Related Misconduct Airmen under 21 account for only 9% of our total population

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 Alcohol-Related Misconduct: CoRC FY 06 ~ 5961 counts of Alcohol Related Misconduct (ARM) in FY06 31% Driving While Intoxicated (DWI) or Driving Under the Influence (DUI) 25% Underage Drinking 15% Domestic Violence or Other Crimes Against People or Pets/Family Maltreatment 8% Drunk and Disorderly 7% Duty Related Incident 5 % Accidental Injury 4% Public Intoxication 3% Crimes Against Property 2% Contributing to the Delinquency.02% Open Container Greatest mission impact from alcohol misuse not alcoholism!

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 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

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 CSAPP Historical Overview DOD Drug Demand Proposal Comprehensive Approach to Substance Abuse Smart Testing – 1 Oct 2004 Original CSAPP Model Team Awareness SHARP Program Edwards Program Vandenberg's ALCON Piloted at 4 AFBs

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 Air Force Instructions AFI 44-107 Civilian Drug Testing Program AFI 44-120 Drug Abuse Testing Program AFI 44-121 Alcohol and Drug Abuse Prevention and Treatment (ADAPT) Program AFI 44-159 Demand Reduction Program AFI 90-501 Community Action Information Board and Integrated Delivery System

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 Additional Research Sources 2002 NIAAA: “A Call to Action: Changing the Culture of Drinking at US Colleges” 2003 Institute of Medicine (IOM) “ Reducing Underage Drinking: A Collective Responsibility” 2003 “Preventing Workplace Substance Abuse: Beyond Drug Testing to Wellness”

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 The best models for change…

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 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

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 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

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 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

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 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 Commander’s 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

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 Prevention: 0-0-1-3 Results  68%  64%  93%

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 0-0-1-3’s 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

29. 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 29 The Road from CSAPP and 0-0-1-3 to CoRC…..

30. 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 30 Corona Tasker Develop a plan to incorporate 0-0-1-3 with other “Culture of Airman” initiatives OPR: AF/DP OCR: SAF/MR,AF/SG,AF/SE,SAF/IE,AETC, AFSPC Suspense: Brief at Corona Top 05 AF/DP co-lead with SG (HQ ADAPT/DR) Established IPT of stakeholders DP, SG, JA, SFS, ILV, CCC, PA, HC, AETC, others

31. 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 31 CSAF: Basics for CoRC Guiding principles Commander’s 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!

32. 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 32 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

33. 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 33 CoRC: AF Functional Community Players Public Affairs Legal Security Forces Medical Treatment Facility Chaplains Mission Support/ Services Senior Leadership CC/1 st Sergeants

34. 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 34 2. 2. INDIVIDUAL LEVEL 3.BASE COMMUNITY 4. LOCAL COMMUNITY 1. LEADERSHIP INTEGRATED 4-PRONGED COMMUNITY APPROACH

35. 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 35 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

36. 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 36 Culture of Responsible Choices (CORC) All 72 SG toolkit documents found at: www.afcrossroads.comwww.afcrossroads.com Bucket 1: Resources for universal/primary prevention through population-level outreach and screening Bucket 2: Resources for selected/secondary prevention through targeted, individualized, non-anonymous alcohol and drug screening at Primary Care/Flight Medicine during PHA and routine care Bucket 3: Resources for Behavioral Health targeted prevention through assessment for alcohol related problems (misuse, abuse, and dependence) and drug use at all Life Skill's intakes Bucket 4: Resources for ADAPT/DDR staff to use in their role as the Commanders' substance use subject matter experts

37. 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 37 Summary Development of CoRC 2005 DOD Survey of Health- Related Behaviors ARIs Drug Positives CSAPP

38. 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 38 Summary NIAAA – “A Call to Action: Changing the Culture of Drinking at College Campuses” IOM – “Reducing Underage Drinking: A Collective Responsibility” F. E. Warren 0-0-1-3 program CORONA Tasker

39. 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 39 Questions ?

40. 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 40 2. 2. INDIVIDUAL LEVEL 3.BASE COMMUNITY 4. LOCAL COMMUNITY 1. LEADERSHIP INTEGRATED 4-PRONGED COMMUNITY APPROACH