Plain-English glossary

Alcohol and Drug Abuse Prevention and Treatment. The Air Force's substance use treatment program, available at Lackland AFB and Randolph AFB. Handles voluntary self-referrals as well as command-directed cases. The program that active-duty Air Force personnel at JBSA use when seeking substance use treatment through military channels.

The maximum amount TRICARE will pay for a specific service. If a provider charges more than the allowed amount and is not in-network, the patient may owe the difference on top of their cost-share. In-network providers agree to accept the TRICARE allowed charge as full payment, which is why in-network care reduces out-of-pocket costs.

The amount you pay for covered services before TRICARE begins paying its share. Deductibles vary by plan and status. TRICARE Prime active-duty family members pay $150 per individual or $300 per family (verify current amounts at tricare.mil). After you meet the deductible, you pay only your cost-share percentage for the rest of the benefit year.

Army Substance Abuse Program. The Army's substance use counseling, treatment, and prevention program. Located at Fort Sam Houston for JBSA-based Army personnel. Handles voluntary self-referrals with confidentiality protections, as well as command-directed cases. The program coordinates with civilian treatment providers when a military treatment facility cannot provide the required level of care.

Approval from TRICARE or TriWest that a specific treatment is medically necessary before you receive it. Also called prior authorization. Required for residential treatment and PHP. Without it, TRICARE may not pay for the care. Your treatment center submits the authorization request; you should confirm it has been approved before showing up for admission. See also: Prior authorization.

The 12-month period during which your TRICARE benefits, deductible, and catastrophic cap apply. For most TRICARE plans the benefit year runs January 1 through December 31. Deductibles reset at the start of each new benefit year, even if you are mid-treatment.

An FDA-approved medication used in medication-assisted treatment (MAT) for opioid use disorder. Reduces withdrawal symptoms and cravings. Available as a sublingual film or tablet, often as a combination product with naloxone (brand names include Suboxone). TRICARE and VA both cover buprenorphine when prescribed by a licensed provider. See also: MAT, Naltrexone.

The maximum amount you pay out of pocket for covered TRICARE services in a benefit year. Once you reach the cap, TRICARE pays 100% of authorized covered services for the rest of the year. The cap amount varies by plan and status: active-duty family members on Prime have a lower cap (approximately $1,000 per family) than retirees. Verify the current-year cap at tricare.mil because it may be adjusted annually.

A structured, evidence-based form of psychotherapy that helps people identify and change thought patterns that lead to harmful behaviors. One of the most widely used and well-researched therapeutic approaches in addiction treatment. Also effective for co-occurring PTSD, depression, and anxiety. A treatment program that does not include CBT or a similarly evidence-based modality is missing a core component.

The presence of both a substance use disorder and a mental health condition in the same person at the same time. Also called dual diagnosis. PTSD and alcohol use disorder are among the most common co-occurring combinations in veterans. Treating one without addressing the other leads to poorer outcomes for both. Effective treatment addresses both simultaneously through an integrated approach.

The portion of a covered service's cost that you pay after your deductible is met. Expressed as a percentage of the TRICARE allowed charge. For example, if the cost-share is 20% and the allowed charge for a day of residential treatment is $600, your cost-share for that day is $120. The cost-share rate varies by plan type, your status, and whether you use in-network or out-of-network care.

The full range of addiction treatment services, from most intensive (medical detox and residential) to least intensive (standard outpatient and aftercare). A comprehensive continuum-based approach means stepping down through levels of care as the patient stabilizes, rather than discharging directly from residential to no treatment. Programs that plan and support this step-down process have better long-term outcomes.

The medically supervised process of managing withdrawal as a substance clears the body. Detox treats the physical dependence only; it is not addiction treatment by itself. Alcohol and benzodiazepine withdrawal can cause dangerous complications including seizures and requires close medical supervision. Opioid withdrawal is rarely life-threatening but is severely uncomfortable. Detox typically lasts 3 to 10 days and is followed by a transition to the appropriate level of addiction treatment.

See: Co-occurring disorders. A clinical term for the simultaneous presence of a substance use disorder and one or more mental health conditions. Relevant for veterans because PTSD, depression, and anxiety are frequently present alongside addiction. Ask any treatment program directly whether they provide integrated dual-diagnosis treatment before enrolling.

The Texas state agency that licenses and regulates addiction treatment facilities. A facility must hold a current DSHS license to legally operate as an addiction treatment provider in Texas. You can verify a facility's licensing status at dshs.texas.gov. Valid licensure is a baseline requirement before considering any program, but it does not constitute an endorsement of quality or a guarantee of outcomes.

An evidence-based therapy used primarily for trauma and PTSD. Involves guided eye movements or other bilateral stimulation while processing traumatic memories. Widely used in VA and civilian treatment programs for veterans. Particularly relevant for programs treating co-occurring PTSD and substance use disorder. The VA considers EMDR a first-line treatment for PTSD.

A statement from TRICARE that shows what was billed by a provider, what TRICARE paid, and what amount remains your responsibility. An EOB is not a bill. The actual bill comes separately from the provider. Reading the EOB alongside the provider's bill lets you verify the amounts match and catch any errors. If you disagree with what TRICARE covered, the EOB is the starting point for filing an appeal.

A treatment facility or provider that has a contract with TriWest to provide TRICARE-covered services at negotiated rates. In-network providers accept the TRICARE allowed charge as full payment, which significantly reduces your out-of-pocket costs. Under TRICARE Prime, non-emergency care from out-of-network providers is generally not covered except through the point-of-service option. Under Select and Reserve Select, you can use out-of-network providers at a higher cost-share.

A structured outpatient treatment program typically consisting of three hours of group and individual therapy per day, three to five days per week. You live at home or in sober living during IOP. Often follows residential treatment or PHP as a step-down. Provides more structure and support than standard outpatient while allowing you to maintain work, school, or family responsibilities. TRICARE covers IOP; prior authorization requirements vary by plan. See also: PHP.

A treatment model that addresses co-occurring mental health and substance use disorders simultaneously in a coordinated, unified program, rather than treating them separately in different settings. Considered the standard of care for veterans with PTSD and substance use disorder. A program that treats addiction and then refers you elsewhere for PTSD is not providing integrated treatment.

The military legal corps. JAG officers provide free legal advice to eligible service members and dependents on matters including security clearance implications of substance use treatment, military administrative proceedings, and personal legal issues. At JBSA, legal assistance offices are available at Fort Sam Houston and Lackland. Consulting a JAG officer before making decisions about self-referral and disclosure is strongly recommended for active-duty members with security clearances.

The intensity and structure of addiction treatment, ranging from most intensive (medical detox and residential) to least intensive (standard outpatient). The appropriate level of care is determined by clinical assessment based on the substance involved, severity of dependence, medical and psychiatric history, and home environment. TRICARE covers all five primary levels of care: medical detox, residential, PHP, IOP, and outpatient. The ASAM criteria are the most widely used clinical framework for determining appropriate level of care.

The use of FDA-approved medications in combination with counseling to treat opioid or alcohol use disorder. Common medications include buprenorphine, naltrexone, and methadone for opioid use disorder, and naltrexone and acamprosate for alcohol use disorder. MAT is an evidence-based approach supported by extensive clinical research. TRICARE and VA both cover MAT when prescribed by an authorized provider. A program that does not offer MAT as an option may not be appropriate for opioid use disorder.

The clinical justification that a specific treatment or level of care is appropriate and necessary for a patient's condition. TRICARE requires that care meet medical necessity standards before it will pay. For addiction treatment, medical necessity documentation is submitted by the treatment facility as part of the prior authorization request. If TRICARE denies a prior authorization claim, the denial often cites lack of medical necessity, which can be challenged through the appeals process.

A licensed mental health professional who provides free, confidential, short-term non-medical counseling to military service members and their families. Available on and around JBSA installations. MFLC sessions do not generate a medical record and are not reported to the chain of command, making them a confidential resource for family members navigating substance use or mental health concerns. Access through Military OneSource at 1-800-342-9647 or militaryonesource.mil.

A Department of Defense program providing free, confidential resources and counseling for active-duty, National Guard, and Reserve members and their families. Available 24 hours a day at 1-800-342-9647. Offers benefits navigation, referrals to local resources, and free counseling sessions for family members. A key resource for military spouses seeking guidance on helping a loved one access treatment without command involvement.

An FDA-approved medication used in MAT for both opioid and alcohol use disorder. Blocks opioid receptors, reducing the rewarding effects of alcohol and opioids. Available as a daily oral tablet or as a monthly injection (brand name Vivitrol). Unlike buprenorphine, naltrexone is not a controlled substance and does not carry risk of diversion, which can make it a more accessible option in some circumstances. Covered by TRICARE and VA.

A provider that does not have a contract with TriWest but is still authorized to provide TRICARE-covered services. Differs from a completely out-of-network provider in that non-network providers have agreed to TRICARE's billing rules but charge at higher rates. Under Select and Reserve Select, you can see non-network providers at higher cost-shares. Under Prime, non-network care is generally limited to emergency situations.

A provider that has no contract with TriWest or TRICARE. Using an out-of-network provider under TRICARE Select or Reserve Select means higher cost-shares and potentially owing the difference between what the provider bills and what TRICARE allows. Under TRICARE Prime, using an out-of-network provider for non-emergency care typically means the care is not covered at all, except through the point-of-service option at significantly higher cost.

The total amount you pay for covered healthcare services, including your deductible, cost-share, and any applicable copays. Does not include premiums. Out-of-pocket costs are limited annually by the catastrophic cap. Understanding your current deductible status and how close you are to the catastrophic cap helps estimate what a course of treatment will actually cost you.

Addiction treatment that does not require living at a treatment facility. Ranges from standard outpatient (weekly individual or group sessions) to intensive outpatient (IOP, multiple sessions per week) to partial hospitalization (PHP, near-daily structured programming). Outpatient levels of care allow you to maintain work, school, and family responsibilities while in treatment. TRICARE covers all outpatient levels of care; prior authorization requirements vary by intensity.

A structured day treatment program providing four to six hours of therapy, five days a week. More intensive than IOP but does not require residential stay. You live at home or in sober living during PHP. Used as a step-down from residential treatment or as an alternative to residential when the home environment is stable. TRICARE covers PHP with prior authorization. See also: IOP, Continuum of care.

An option under TRICARE Prime that allows you to see a provider outside the Prime network without a referral. You pay a higher cost-share (typically 50% of allowed charges) and a separate deductible. Rarely cost-effective for extended treatment but provides access in situations where no in-network provider is available. Confirm the point-of-service option applies to behavioral health services under your specific plan.

Approval from TRICARE or TriWest that a specific course of treatment is medically necessary before you receive it. Required for residential treatment, PHP, and often IOP. Your treatment center initiates the prior authorization request and provides clinical documentation to TriWest. The timeline from request to decision is typically a few business days for standard cases. Authorization must be obtained before admission for residential treatment; care received without authorization may not be covered. See also: Utilization review.

A mental health condition that can develop after exposure to a traumatic event. Common in veterans. Symptoms include intrusive memories, nightmares, hypervigilance, emotional numbing, and avoidance. PTSD frequently co-occurs with substance use disorder, particularly alcohol use disorder, as alcohol is often used to manage PTSD symptoms before treatment. Both TRICARE and VA cover PTSD treatment, and integrated treatment addressing both conditions simultaneously is the standard of care for veterans.

A level of care where you live at the treatment facility and receive 24-hour structured programming. Also called inpatient treatment. Typically 28 to 90 days, though extended programs run longer for complex cases. Provides the most intensive treatment environment outside of hospital-based care. TRICARE covers residential treatment with prior authorization. Medical necessity documentation from the treatment team determines how many days are authorized. See also: Level of care, Prior authorization.

The Navy and Marine Corps equivalent of Army ASAP and Air Force ADAPT. Handles voluntary self-referrals and command-directed cases for Navy and Marine personnel. Navy and Marine personnel at JBSA fall under SARP procedures, not ASAP or ADAPT. Voluntary self-referral carries protections under DoD Instruction 1010.04.

When a service member voluntarily initiates contact with a substance use treatment program before any command involvement, drug test failure, or disciplinary action. Self-referral generally carries stronger confidentiality protections and lower risk of adverse career action than command-directed treatment. At JBSA, Army personnel self-refer through ASAP; Air Force personnel through ADAPT. The decision to self-refer before a problem is identified through other means can be a significant factor in career outcomes. Always consult a JAG officer for individual guidance.

The clinical term for addiction, as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Replaces older terms such as "substance abuse" and "substance dependence." Includes alcohol use disorder, opioid use disorder, stimulant use disorder, and others. Classified as a chronic medical condition, not a moral failing. TRICARE and VA cover SUD treatment across all primary levels of care.

The process of moving from a more intensive level of care to a less intensive one as a patient stabilizes and progresses in treatment. For example, moving from residential to PHP, then to IOP, then to standard outpatient. Programs that plan and support step-down transitions have better long-term outcomes than programs that discharge patients without a continuing care plan. TRICARE authorizes step-down levels of care based on ongoing medical necessity documentation.

A structured, supervised living environment for people in recovery, providing a drug-free setting between residential treatment and independent living. Residents typically attend outpatient treatment and work or attend school while living in the sober living home. Sober living is not directly covered by TRICARE but can make PHP and IOP levels of care viable by providing a stable, drug-free home environment during treatment.

Authorization to access classified information, required for many military positions. The National Security Adjudicative Guidelines (Guidelines G and H) address alcohol and drug issues in security clearance adjudication. Voluntary treatment for substance use disorder is generally viewed as a mitigating factor, meaning it can actually support a clearance rather than jeopardize it, compared to untreated addiction. Consult a JAG officer or security clearance attorney before making any decisions about disclosure and treatment to understand the implications for your specific situation.

The healthcare program covering active-duty service members, veterans, retirees, and their families. Administered by the Defense Health Agency, with regional contracts managed by civilian contractors. In San Antonio and the surrounding area, TRICARE is managed by TriWest Healthcare Alliance. TRICARE covers addiction treatment across all plan types, including detox, residential, PHP, IOP, and outpatient. Coverage specifics vary by plan.

TRICARE coverage for military retirees and their dependents who are entitled to Medicare. TFL acts as a secondary payer after Medicare. Most costs covered by Medicare are also covered by TFL, resulting in little to no out-of-pocket cost for most covered services. For addiction treatment, Medicare covers inpatient and outpatient substance use disorder services; TFL covers most remaining costs. Verify your specific situation with TriWest and Medicare.

A managed care option that functions similarly to an HMO. Requires enrollment and assignment to a primary care manager (PCM). Referrals from the PCM are needed for specialty care including addiction treatment at civilian facilities. Offers the lowest cost-shares of any TRICARE plan. Active-duty service members are automatically enrolled in TRICARE Prime. Active-duty family members may enroll. Available in areas with sufficient network providers, including San Antonio.

A premium-based health plan for qualified National Guard and Reserve members and their families who are not covered under another TRICARE plan. Works similarly to TRICARE Select: no referrals needed, in-network and out-of-network options available at different cost-shares. Coverage for addiction treatment follows the same rules as Select. Prior authorization is required for residential and PHP.

A preferred provider option that functions similarly to a PPO. No enrollment in a specific primary care manager required, and no referrals needed for specialty care including addiction treatment. Higher cost-shares than Prime but more flexibility in provider choice. In-network providers have lower cost-shares than non-network providers. Available to active-duty family members, retirees, and National Guard and Reserve members in most areas.

TriWest Healthcare Alliance, the TRICARE regional contractor for the West region, which includes San Antonio and all of Texas. TriWest processes claims, manages the provider network, handles prior authorization requests, and administers TRICARE benefits for members in the region. When you call to verify coverage or need a prior authorization, you are calling TriWest. The TriWest website and phone line are the primary points of contact for benefits verification in San Antonio.

The ongoing process by which TRICARE or TriWest reviews whether continued treatment remains medically necessary. For residential treatment, your treatment team submits updated clinical documentation on a regular basis to justify continued authorization beyond the initial approved period. If utilization review determines that a lower level of care is appropriate, TRICARE may not authorize additional days at the current level. Your treatment team manages this process.

The broader system of controls TRICARE uses to ensure that covered services are medically necessary and appropriate. Includes prior authorization, concurrent review (utilization review during treatment), and retrospective review (review after treatment). A treatment facility experienced with TRICARE knows how to navigate utilization management processes, which reduces disruptions in care.

The federal department that provides benefits and services to eligible veterans, including healthcare, mental health treatment, and substance use disorder treatment. In San Antonio, VA care is provided through the Audie L. Murphy VA Medical Center and affiliated community-based outpatient clinics. Eligible veterans can access VA substance use disorder programs separately from or in addition to TRICARE. VA care generally does not involve cost-shares for enrolled veterans receiving care within the VA system.

A free, confidential crisis support service available to veterans, service members, and their families. Available 24 hours a day, 7 days a week. Dial 988 then press 1 to reach a Veterans Crisis Line responder. Text 838255. Chat at veteranscrisisline.net. Staffed by responders many of whom are veterans themselves. Not a treatment placement service, but a source of immediate support and connection to local resources.