Management of Substance Use Disorders (SUD) (2015)

This is a clinical practice guideline for the management of substance use disorders. It provides evidence-based recommendations for healthcare practitioners. The guideline aims to improve patient outcomes and enhance the health and well-being of patients with SUD. It is intended for healthcare practitioners in the DOD and VA health care system.

Running head: MANAGEMENT OF SUBSTANCE USE DISORDERS (SUB) (2015) 1
Management of Substance Use Disorders (SUD) (2015)
Name
Institutional Affiliation

MANAGEMENT OF SUBSTANCE USE DISORDERS (SUB) (2015) 2
MANAGEMENT OF SUBSTANCE USE DISORDERS (SUB) (2015)
SUD (2015) Overview
This is a clinical practice guideline for the management of substance use disorders. It
gives a description of critical decision points in the managing substance use disorder. It provides
precise and detailed evidence-based recommendation integrating current information alongside
practices for providers throughout the DOD and VA health care system. SUD (2015) main
intention is to prove patient outcomes alongside management of patients with substance use
disorder. The release of SUD (2015) guideline has led to an expanded general knowledge as well
as understanding of SUD.
The enhanced recognition of complicated nature of such conditions has culminated in the
adoption of novel strategies to manage as well as treat patients with SUD and this has included
new development linked to pharmacotherapy and additional options for treatment. This guideline
is aimed at helping healthcare practitioners in each aspect of caring for patient and include
diagnosis, treatment as well as follow-up. This system-broad goal of evidence-based guideline is
to enhance the health and well-being of patients by guiding health practitioners who care for
patients with SUD along the pathways of management that are backed by evidence. The
anticipated outcome of successful SUD (2015) guideline implementation include the following:
 Assessing the condition of a patient and determining the best method of treatment in
collaboration with patient.
 Emphasizing the use of patient-centric care.
 Minimizing preventable morbidity and complications
 Optimizing the recovery of each patient to lower or remove consumption, enhance health
and wellbeing, live a self-directed life as well as strive to hit his full potential.

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Discuss how different professionals in the healthcare system
This guideline denotes a substantial step towards enhancing and treating and managing
patient with SUD in DOD and VA. It is intended for DOD and VA healthcare practionares.
These providers include nurse practitioners, physicians, physician assistants, social workers,
psychologists, nurses, chaplains, and pharmacists, addiction counselors among other people
engaged in care of service members as well as veterans with suspected or diagnosed SUD.
The nurses are encouraged to utilize a patient-centric care approach which is
individualized anchored on patient needs, capabilities, goals, previous treatment experience
alongside preferences. Irrespective of the practitioner settings, this guideline dictate that each
nurse must give patients in the healthcare system access to evidence-based interventions suitable
to such a patient. When the nurse properly utilize this guideline, they will decrease the anxiety of
the patients, boost trust in clinicians as well as improve the adherence to treatment.
It will also improve patient-clinicians communication via patient-centric care. The
guideline dictates all the nursing professionals to review the outcomes of the past self-change
attempts, previous treatment experiences, as well as outcomes. They must also ask the patients
regarding their willingness to accept any referral to the addictions specialists and also they are
demanded to involve each patient in the problem prioritization to be tackled and in setting
particular goals irrespective of the setting or care level selected (World Health Organization,
2016).
Addiction counselors are required to involve patient in shared decisions. In the entire
VA/DOD clinical care guideline, these people must focus on shared decision making. This is
because the patients suffering from SUD alongside addictions counselors make decisions about

MANAGEMENT OF SUBSTANCE USE DISORDERS (SUB) (2015) 4
specific care to engage in. Therefore, this guideline dictates that these professional must provide
sufficient information to these patients so that they can make informed decisions. Thus, addiction
counselors are tied to this guideline because they have to be adept at presenting useful
information to their patients about both individual treatments alongside the care location and
levels (Wakeman, Pham-Kanter & Donelan, 2016).
For instance, this guideline dictates addiction counselor to briefly explore of a patient
who rejects referral to specialty care and also present the appropriate as well as individualized
information regarding how such specialty care could better meet the needs of the patients,
identifying reasons for recommending specialty referral. The addiction counselor is also required
to provide the customer the desired information about the abilities alongside the limitations of
general metal health clinic or primary care. In case the patient is adamant and further decline the
referral to specialty care even after the counselling, the addiction counselor is required offering
the primary care is tied by this guideline to respect the patient’s decision and provide as much as
feasible for patient (Walker & Druss, 2017).
Physicians, nurse, and physicians are tied to this guideline when offering addition-
focused medical management. As these professionals offer this manualized intervention intended
for delivery by nurse, physician and physician assistant within the primary care context, they
must follow the guideline recommendations. This is because this guideline has outlined specific
strategies these medical professionals must use to boost medication adherence as well as monitor
the consequences of substance use, and supporting abstinence via referral to support groups and
education (Komaromy et al., 2016).
This guideline defines what these medical professionals need to include when offering
addiction-focused management. They are thus required to monitor self-reported use, lab markets

MANAGEMENT OF SUBSTANCE USE DISORDERS (SUB) (2015) 5
and consequences. They are also required to monitor adherence, treatment response alongside
adverse effects. They are also demanded by this guideline to educate about opioid use disorder
and alcohol use disorder. They are also required to encourage the patient with SUD to abstain
from non-prescribed opioids and addictive substances. They are also required to encourage these
patients to attend community supports for recovery and to make lifestyle alterations supporting
the recovery.
Identify the research/reference used by the system to adopt the guideline
The adoption of the system was preceded by evidence review methodology. The CPG
Champions together with Work Group were given a role to identify the key questions that would
guide the systematic review of literature on the SUD. Such questions were developed in
consultation with Lewin team. The questions tackled the clinical topics of highest preference or
priority for DOD and VA populations. The key questions follow PICOTs framework for
evidence questions as created by Agency for Healthcare Research and Quality (AHRQ).
The champions alongside evidence team undertaken variations iterations of this
procedure, every time narrowing the CPG scope and literature review by prioritizing topic of
interest. The systematic review of literature was extensively conducted using the search strategy
and terms which identified up to 4708 citations that potentially addressed the KQs to this
evidence review. 2100 citations were excluded after title review for apparently not meeting the
criteria for inclusion. 2608 abstracts were then reviewed and 1621 of them were excluded. 987
full-length articles got reviewed. 682 were excluded at first pass review and 305 full-length
articles were thought to tackle one or more key questions and got additional review. 184 were
eventually excluded. 135 citations tackled one or additional key questions and were taken as
evidence in this review.

MANAGEMENT OF SUBSTANCE USE DISORDERS (SUB) (2015) 6
Define the evidence used to define the guideline
The present document is the update to 2009 VA/VOD clinical practice guideline for
managing SUD. In defining this guideline, the evidence was based on a systematic review of
both the epidemiological and clinical evidence. The guideline’s development was that anchored
on the panel of multidisciplinary experts and this makes it offer a precise explanation of logical
relationship between many care options alongside health outcomes as the quality of evidence
alongside strength of recommendations (Erskine et al., 2015).
Determine the level of evidence used in the EBP identified
The guideline has a higher level of evidence. This is because it was developed via an
iterative peer review process whereby the Work Group generated multiple drafts of the clinical
practice guideline. The draft was sent out for peer reviews as well as comments after a near-final
draft was agreed by all the champions of this guideline. It was posted for fourteen business days
in the wiki website. These peer reviewers composed of people working within DOD and VA
health systems alongside experts from suitable external organizations designated by the members
of the Work Group.
Moreover, the DOD and VA leadership included external and internal peer reviewers and
solicited their effective feedback on this guideline. For transparency, all reviewers’ feedback
was posted in the tabular format form on wiki site besides the name of reviewers. The discussion
and consideration was performed by Work Group and desired modifications was effected
throughout the guideline development course based on the evidence. Such an intensive and
thorough peer review gives this guideline the required evidence. This is because the modification
were only based on evidence. This means that the guideline was pre-tested before being sent out
for implementation (Priester et al., 2016).

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The grading recommendations used in this guideline also makes the quality of evidence
effective. The use of GRADE methodology was effective in assessing the evidence base quality
and assigning grade for the strength of every recommendation. Such a system of GRADE used
effective four domains that helped assess the strength of every recommendations. The first
domain was balance of desirable as well as undesirable outcomes. The second domain was
confidence in the evidence quality while third domain was values and preferences. Other
implications as required included equity, resource use, acceptability, feasibility and subgroup
considerations (DuPont, Compton & McLellan, 2015).
Provide an opinion on how well this guideline is followed by professionals in the system
In my view, this guideline is highly and strictly followed by the professionals in the
system. This has been based on the high level of evidence quality used in the guideline. For
example, the four domains used in assessing the quality of recommendations makes these
professionals easily decide whether or not to follow the guidelines. In respect of balance of
desirable and undesirable outcomes provides the expected benefits (like increased longevity,
morbid event reduction, symptoms resolution, and improved QoL, as well as declined use of
resource) and harms (like decreased longevity, adverse event, immediate severe complications,
impaired QoL, increase use of resource, inconvenience) comparative to one another (Velasquez,
Crouch, Stephens & DiClemente, 2015).
In my view, this is a useful domain that increases the chances of health professionals
following the guidelines. This is because it is correct that majority of the health professionals
will provide therapeutic and preventive measures provided the advantage of intervention surpass
the adverse effects and risks (Collins, Musisi, Frehywot & Patel, 2015). The uncertainty or
certainty of a health professional regarding the benefit-risk balance shall significantly influence

MANAGEMENT OF SUBSTANCE USE DISORDERS (SUB) (2015) 8
the recommendation’s strength. Thus, I believe that this domain will be critical in helping the
clinicians to either follow or refute the recommendations. I believe that when the strength is
higher for a given recommendation, the clinicians will not hesitate but to adopt the
recommendations.
I also believe that the second domain “confidence in quality of evidence” will also make
the health professionals decide whether to follow this guideline. This is because it is a reflection
of the quality of the evidence base as well as the certainty in such an evidence. It shows the
methodological quality of studies for every outcome variable in this guideline. Thus, the health
professionals will likely follow the recommendations with higher strength because they are sur it
is of high level (Akin, Brook & Lloyd, 2015).
Conclusion
SUD (2015) is an effective clinical care practice guideline which has led to better
management and treatment of the persons with SUD. This guideline uses evidence-based
approach that makes it easily adoptable by health professionals and this is the reason why it has
received a wider acceptance. The guideline not only benefits the patients, but also the health
professionals alike. This is because it has recommended evidence-based interventions which are
specific to each patient condition which make it highly followed by the practitioners. Also, the
guideline uses effective domains to help the health professionals test the quality of the
recommendations. Such domains have helped these professionals to choose whether to follow or
not to follow the recommended interventions to manage and treat the people with SUD.

MANAGEMENT OF SUBSTANCE USE DISORDERS (SUB) (2015) 9
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