Recommendation: The Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to incorporate medical screening questions specific to gambling disorder as part of a systematic screening process across DOD, such as DOD's annual Periodic Health Assessment, for behavioral and mental-health issues.

Agency: Department of Defense
Status: Open

Comments: DOD non-concurred with this recommendation. However, the FY 2019 National Defense Authorization Act mandated that DOD implement this recommendation. As of August 2019, DOD had modified the Health Related Behaviors Survey (HRBS) to include questions on gambling and DOD and the Services are in the process of updating the electronic Periodic Health Assessment (PHA) assessment forms to capture the gambling screening data required by the legislation. Once the PHA is updated to include the gambling screening data, we will be able to close this recommendation.

Recommendation: The Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to update DOD Instruction 1010.04, Problematic Substance Use by DOD Personnel, to explicitly include gambling disorder as defined in the 2013 Diagnostic and Statistical Manual of Mental Disorders.

Agency: Department of Defense
Status: Open

Comments: DOD concurred with this recommendation. As of August 2019, DOD stated that this guidance is still in internal DOD coordination. Moreover, guidance related to gambling disorder screening, referral, and treatment needs to be coordinated with the Addictive Substance Misuse Advisory Committee (ASMAC) before issuance, which is anticipated to be July 2020.

Recommendation: The Secretary of Defense should direct the Secretary of the Army to update Army Regulation 600-85, The Army Substance Abuse Program, to explicitly include gambling disorder.

Agency: Department of Defense
Status: Open

Comments: DOD concurred with this recommendation. As of August 2019, the Army did not have any updates to provide on the status of this recommendation.

Recommendation: The Secretary of Defense should direct the Secretary of the Navy to update Naval Operations Instruction 5350.4D, Navy Alcohol and Drug Abuse Prevention and Control, to explicitly include gambling disorder.

Agency: Department of Defense
Status: Open

Comments: DOD concurred with this recommendation. As of August 2019, Navy officials stated that the draft Navy instruction was returned back to the Navy's Drug Detection and Deterrence Program Office to add language regarding the Secretary of the Navy's ban on hemp/CBD products that was announced this month. The Navy has added the language and pushed the instruction out to the main stakeholders for coordination. It is due back to the Director, Navy Staff no later than 30 August 2019 where it will go back into the queue for signature. Navy officials anticipate signature sometime later this fall.

Recommendation: The Commandant of the Coast Guard should update Commandant Instruction M6000.1F, Coast Guard Medical Manual, to classify gambling disorder as an addiction and not as an impulse control issue.

Agency: Department of Homeland Security: United States Coast Guard
Status: Open

Comments: The U.S. Coast Guard/DHS concurred with this recommendation. As of August 2019, the Coast Guard stated that updates to this manual are ongoing. According to Coast Guard officials, including gambling disorder in this manual is one of many significant updates the program is adjudicating for this manual and it's a lengthy clearance process. No timeline was provided for expected issuance.

Recommendation: The Secretary of Defense should direct the Secretary of the Army to implement processes to review and monitor the Army military treatment facility prescribing practices for medications discouraged under the PTSD guideline and address identified deviations.

Agency: Department of Defense
Status: Open

Comments: DOD concurred with this recommendation and stated that any policy that it may issue related to the monitoring of prescribing practices would be directed toward all of the military services. In May 2018 DOD stated that it planned to (1) conduct a comprehensive review of existing prescribing practices for the treatment of PTSD; (2) develop policy guidance for addressing prescribing practices for the management of PTSD that deviate from the clinical practice guideline; and (3) implement an automated dashboard that will flag medications that the PTSD guideline discourages from use. In its February 26, 2020 response, DOD stated that July 30, 2020 is the estimated completion date for these planned actions. To close this recommendation, DOD needs to implement its planned actions and provide documentation showing that the Department is monitoring medications discouraged from use under the PTSD guideline and addressing identified deviations.

Recommendation: To improve DOD's ability to prevent sexual assaults of male servicemembers, to increase its responsiveness to male servicemembers who are sexually assaulted, and to help DOD's sexual assault prevention and response program realize the full benefit of the data it collects on sexual assault incidents, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness, in collaboration with the Secretaries of the military services, to develop a plan for data-driven decision making to prioritize program efforts.

Agency: Department of Defense
Status: Open

Comments: DOD concurred with this recommendation in written comments on our report. In October 2016, DOD published its plan for preventing and responding to sexual assaults of military men. In that plan, DOD generally outlined its intent to develop metrics to assess prevention and response efforts pertaining to males who experience sexual assault. In July 2019, officials from DOD's Sexual Assault Prevention and Response Office stated that DOD's efforts outlined in the October 2016 plan include data-driven decision making. However, DOD has not provided evidence that it has developed a plan for data-driven decision making to prioritize its sexual assault prevention efforts. We will continue to monitor DOD's efforts to address this recommendation.

Recommendation: To improve DOD's ability to prevent sexual assaults of male servicemembers, to increase its responsiveness to male servicemembers who are sexually assaulted, and to address challenges faced by male servicemembers as DOD continues to seek to transform its culture to address sexual assault, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness, in collaboration with the Secretaries of the military services, to develop clear goals with associated metrics to drive the changes needed to address sexual assaults of males and articulate these goals, for example in the department's next sexual assault prevention strategy.

Agency: Department of Defense
Status: Open

Comments: DOD concurred with this recommendation in written comments on our report. In October 2016, DOD issued a plan to prevent and respond to sexual assault of military men. In August 2018, DOD's Sexual Assault Prevention and Response Office (SAPRO) stated that objectives 1-4 of this plan constitute DOD's goals to address sexual assaults of military men. However, the plan does not contain metrics; one of the plan's objectives is to develop metrics to assess prevention and response efforts pertaining to men who experience sexual assault. In July 2019, SAPRO officials stated that they are waiting to complete most actions for objectives 1-3 of the plan before developing associated metrics, and that completion of the metrics is expected by 2024. We will continue to monitor DOD's planned development of metrics for its prevention and response efforts for sexual assault of male servicemembers.

Recommendation: To improve DOD's ability to prevent sexual assaults of male servicemembers, to increase its responsiveness to male servicemembers who are sexually assaulted, and to address challenges faced by male servicemembers as DOD continues to seek to transform its culture to address sexual assault, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness, in collaboration with the Secretaries of the military services, to include information about the sexual victimization of males in communications to servicemembers that are used to raise awareness of sexual assault and the department's efforts to prevent and respond to it.

Agency: Department of Defense
Status: Open

Comments: DOD concurred with this recommendation in written comments on our report. DOD's October 2016 plan to prevent and respond to sexual assault of military men included objectives to develop a unified communications plan tailored to men across DOD, and to improve servicemember understanding of sexual assault against men. Officials of DOD's Sexual Assault Prevention and Response Office stated in July 2019 that DOD estimates that it will complete this task in 2021.

Recommendation: To improve DOD's ability to prevent sexual assaults of male servicemembers, to increase its responsiveness to male servicemembers who are sexually assaulted, and to address challenges faced by male servicemembers as DOD continues to seek to transform its culture to address sexual assault, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness, in collaboration with the Secretaries of the military services, to revise sexual assault prevention and response training to more comprehensively and directly address the incidence of male servicemembers being sexually assaulted and how certain behavior and activities--like hazing--can constitute a sexual assault.

Agency: Department of Defense
Status: Open

Comments: DOD concurred with this recommendation in written comments on our report. DOD's October 2016 plan to prevent and respond to sexual assault of military men contained objectives to develop research-informed training for servicemembers involved with sexual assault prevention and response to improve understanding of male victimization and how to prevent the crime, commander/supervisor training; and gender-responsive treatment guidelines for providers, among other things. Officials of DOD's Sexual Assault Prevention and Response Office stated in July 2019 that DOD expects to complete these tasks in 2021.

Recommendation: To improve DOD's ability to prevent sexual assaults of male servicemembers, to increase its responsiveness to male servicemembers who are sexually assaulted, and to help ensure that all of DOD's medical and mental health providers are generally aware of any gender-specific needs of sexual assault victims, and that victims are provided the care that most effectively meets those needs, the Assistant Secretary of Defense for Health Affairs should, in collaboration with the services' Surgeons General, develop and issue guidance for the department's medical and mental health providers--and other personnel, as appropriate--based on the results of this evaluation that delineates these gender-specific distinctions and the care regimen that is recommended to most effectively meet those needs.

Agency: Department of Defense: Office of the Assistant Secretary of Defense (Health Affairs)
Status: Open

Comments: DOD concurred with this recommendation in written comments on our report. In August 2018, the Office of the Assistant Secretary of Defense for Health Affairs stated that DOD is writing an Instruction and two accompanying Defense Health Agency Procedural Instructions that will delineate gender-specific distinctions and care regimens where appropriate. The guidance will incorporate the findings of a report by the Psychological Health Center of Excellence of the Defense Health Agency resulting from a planned study of the patterns of health care utilization of servicemembers reporting a sexual assault, including any gender differences. As of September 2019, DOD had not yet issued the guidance. We will continue to monitor DOD's actions to implement this recommendation.