Substance Use Disorders – Evidence Based Practices

NIDA Launches Drug Use Screening Tools for Physicians

nidamed

On April 20th, NIDA launched its first comprehensive Physicians’ Outreach Initiative, NIDAMED. NIDAMED gives medical professionals tools and resources to screen their patients for tobacco, alcohol, illicit, and nonmedical prescription drug use. The initiative stresses the importance of the patient-doctor relationship in identifying unhealthy behaviors before they evolve into life threatening conditions. The NIDAMED resources include an online screening tool, a companion quick reference guide, and a comprehensive resource guide for clinicians.

The NIDAMED tools – targeting primary care clinicians – were unveiled at a news conference at the National Press Club that featured NIDA Director Dr. Nora D. Volkow, Acting Director of the Office of National Drug Control Policy Ed Jurith, J.D., Sen. Carl Levin of Michigan, Acting Surgeon General Steven K. Galson, M.D., and representatives from the World Health Organization, the American Medical Association, and other organizations committed to helping patients who struggle with drug-related medical issues.

A patient-tested postcard, designed to compliment the physician screening materials, encourages patients to discuss any and all drug use with their doctors to help ensure proper medical care. Physicians are encouraged to place the postcards in their waiting rooms.

Postcards and Quick Reference Guides are available on NIDA’s research dissemination center, DrugPubs at http://www.drugabuse.gov/Pubcat/ or by calling 1-877-643-2644. The web-based materials can be accessed from www.drugabuse.gov/NIDAMED.

http://www.drugabuse.gov/list/2009/public008.html

Substance Abuse and Mental Health Services (SAMHSA) Resources:

  • The Substance Abuse and Mental Health Services (SAMHSA) provides resources for returning veterans and their families:  http://www.samhsa.gov/vets/
  • SAMHSA publishes a series of Treatment Improvement Protocols (TIPs; http://www.kap.samhsa.gov/products/manuals/tips/numerical.htm) on topics such as depression, co-occurring disorders, clinical issues in intensive outpatient treatment, group therapy, substance abuse treatment for individuals with HIV/AIDS, and integrating substance abuse treatment and vocational services.  TIPs are available at no cost and may be downloaded or ordered online for mail deliver
  • SAMHSA publishes a series of Technical Assistance Publications (TAPs; http://kap.samhsa.gov/products/manuals/taps/index.htm).  These manuals, guidelines, and checklists address issues such as counseling competencies for providers and their supervisors, monitoring alcohol and other drug confidentiality compliance, and welfare reform and substance abuse treatment confidentiality.  TAPs are available at no cost and may be downloaded or ordered online for mail delivery.
  • SAMHSA houses the National Registry of Evidence-based Programs and Practices (http://www.nrepp.samhsa.gov/).  NREPP is a searchable database of interventions for the prevention and treatment of mental illness and substance use disorders. SAMHSA has developed this resource to help people, agencies, and organizations implement programs and practices in their communities.

Department of Veterans Affairs:  Substance Use Disorders:

Screening:

  • Audit-C (http://www.queri.research.va.gov/tools/alcohol-misuse/)
    • Clinical reminder completed on all VA outpatients annually
    • Along with the Drug Abuse Screen, Audit-C is completed as part of the VA Nursing Admission Assessment on medically hospitalized patients
  • Veterans Alcoholism Screening Tool (VAST):  Includes the 24 items of the Michigan Alcoholism Screening Test (MAST) and adds 3 questions that identify specific time periods for responses indicating alcoholism.
  • Global Appraisal of Individual Needs (GAIN) Short Screener (GAIN-SS): 20-item instrument that screens and accurately identifies clients for specific behavioral health disorders, with 5 items for each—internalizing psychiatric disorders, externalizing psychiatric disorders, substance use disorders, and crime/violence problems http://www.chestnut.org/li/gain/GAIN_SS/index.html
  • Opioid Risk Tool (ORT):  5-item tool that assesses risk for individuals developing aberrant behaviors when prescribed with opioids for chronic pain (Webster LR, Webster RM.  Predicting aberrant behaviors in opioid-treated patients:  Preliminary validation of the Opioid Risk Tool.  Pain Medicine.  2005;6(6):432-42).
  • NIAAA A Pocket Guide for Alcohol Screening and Brief Intervention, 2005 Edition:  http://pubs.niaaa.nih.gov/publications/Practitioner/PocketGuide/pocket.pdf

Assessment:

Treatment (for additional information on each clinical practice, refer to the indicated website, and for peer-reviewed journal articles, refer to http://www.pubmed.gov):

Pharmacotherapies: (refer to http://www.pubmed.gov for peer-reviewed journal articles):

Centers on Evidence-based Practices:

  • The Department of Veterans Affairs also has a Center of Excellence on Implementing Evidence-Based Practices (www.ciebp.research.va.gov).  While this site did not list EBPs per se, it did list current research studies that they are currently contracting, including the following:
    • Evaluation of Stepped Care for Chronic Pain in Iraqi/Afghanistan Veterans
    • Improving the Quality and Safety of Opioid Prescribing in Primary Care
  • Veterans Evidence-Based Research Dissemination Implementation Center (VERDICT)
    VERDICT’s mission is to foster a knowledge-based health care system in which clinical, managerial, and policy decisions are based upon sound information from research findings. The multidisciplinary team addresses systematic implementation of evidence in clinical practice within the Veterans Health Administration, leading to integrated models of care and improved service, quality and efficiency. The primary academic affiliate is the University of Texas Health Science Center at San Antonio.  UT Health Science Center investigators were recently awarded a $25 million grant from the Department of Defense (DoD) to lead a research consortium “STRONG STAR” in which VERDICT is participating to study post-traumatic stress disorder among veterans returning from Iraq and Afghanistan. San Antonio is also home to the San Antonio Military Medical Center (formed from Brooke Army Medical Center and Wilford Hall Medical Center) and the United States Army Institute of Surgical Research, which respectively serve as one of the major trauma centers and the only burn center for all military personnel worldwide.  http://www.verdict.research.va.gov/.

Department of Veterans Affairs Pocket Guides:

SAMHSA: United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration
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