According to research published by the National Institutes of Health, service members with prior substance misuse or mental health conditions were 3.9 times and 6.3 times, respectively, more likely to receive a disordered gambling diagnosis than those without substance misuse or mental illness history.

The reissuance of Department of Defense Instruction 1010.04, “Problematic Substance Use and Gambling Disorder,” in January 2025 demonstrates the DOD’s and the Military Health System’s commitment to service members by establishing policies, assigning responsibilities, and prescribing procedures for problematic substance use and gambling disorder prevention, identification, assessment, diagnosis, and treatment for eligible MHS beneficiaries.

Significant updates include:

• Incorporating the prevention, identification, assessment, diagnosis, and treatment of gambling disorder
• Expanding upon the roles and responsibilities of the Addictive Substance Misuse Advisory Committee
• Establishing the addiction medicine personnel serving as champions of substance use disorder care and training
• Expanding the education and training requirements for all mental health providers, treatment staff, commanders and leadership, and DOD personnel in both active and reserve components
• Implementing adherence, documentation, and confidentiality standards, including consent for treatment and resource-sharing best practices

U.S. Navy Cmdr. (Dr.) Elle Marie Schollnberger, director of mental health for the Office of the Assistant Secretary of Defense for Health Services Policy and Oversight, said the DOD emphasizes prevention and early detection practices to reduce the harm and progression of health risks from substance use, including alcohol.

“Substance use and gambling disorders can impact mission readiness and productivity, as well as a service member’s physical and mental health,” said Schollnberger, a board-certified psychiatrist for almost a decade providing care to service members and families at military hospitals and clinics and during deployments.

Expansion of education and training within the document provides a holistic approach to problematic substance use and gambling disorders enabling these concerns to be targeted for prevention, identification and assessment for treatment.

The 2018 Health Related Behaviors Survey data showed that 34% of active duty service members engaged in binge drinking (consuming five or more drinks for men and four or more for women on the same occasion), 9.8% engaged in heaving drinking (binge drinking on at least one or two days a week in the past 30 days) and 6.2% experienced one or more serious consequences from drinking.

Dr. Jonathan Wolf, a senior psychiatrist at the Defense Health Agency, said providing expertise and oversight to improve quality of care concerning substance and addiction treatments for service members across the DOD is a priority due to its impact on service members’ health and individual readiness.

“Co-occurring post-traumatic stress disorder and alcohol use disorder, AUD, may be related to unique factors associated with military service, such as aspects of military culture, deployment, and trauma exposure,” he said. “As part of its public health approach, DOD is committed to the health, well-being, and readiness of service members and their families through promotion of and engagement in prevention, screening, early detection, education, training, and outreach initiatives.”

Some military members may fear their careers will be negatively impacted if they report having substance or gambling addictions or possible dismissal from service. According to Wolf, they do not need to have those concerns. There are treatments and counseling available to get them healthy and return to their units.

“DOD military personnel will be returned to full duty once they have been clinically deemed by appropriately credentialed providers to be on a path towards recovery from the episode and following problematic substance use and gambling disorder treatment whenever consistent with mission requirements,” he said.

Command notification by health care providers is prohibited for protected health information when a service member voluntarily requests mental health care or substance misuse education, unless the service member authorizes the notification or the disclosure. However, providers can inform leadership if they believe there is a serious risk of self-harm, harm to others, or harm to mission, and more specific reasons to notify leadership are available at DODI 6490.08.

Schollnberger said one of the goals of this policy reissuance is improving the health, well-being, and readiness of service members and their families through substance use and gambling disorder education and prevention.

“This approach empirically addresses the whole continuum of care with involvement of those who are connected to DOD personnel in both active and reserve components,” she said. “The DOD fosters a culture of support and strives to create an environment that promotes help-seeking behaviors and reduces the stigma for help-seeking in the provision of mental health care and voluntarily sought substance misuse education.”