National Quality Forum Evidence-Based Practices
In 2004, the National Quality Forum convened a workshop attended by payers, policymakers, researchers and substance abuse treatment providers to begin to outline a set of treatment standards that are well-established in the research literature. The results of this workshop were used as a basis for the development of detailed consensus statements that outline evidence-based practices for the treatment of substance use conditions.
In 2007, the National Quality Forum announced the release of a set of eleven consensus statements outlining evidence-based practices, organized into four domains:
- Identification of substance use conditions
- Initiation and engagement into treatment
- Therapeutic interventions to treat substance use illnesses
- Continuing care management for substance use illnesses.
The eleven endorsed evidence-based practices are:
Identification of Substance Use Conditions
Screening and Case Finding
- During new patient encounters and at least annually, patients in general and mental health care settings should be screened for at-risk drinking, alcohol use problems and illnesses, and any tobacco use.
- Health care providers should employ a systematic method to identify patients who use drugs that considers epidemiologic and community factors and the potential health consequences of drug use for their specific population.
Diagnosis and Assessment
- Patients who have a positive screen for—or an indication of—a substance use problem or illness should receive further assessment to confirm that a problem exists and determine a diagnosis. Patients diagnosed with a substance use illness should receive a multidimensional, biopsychosocial assessment to guide patient-centered treatment planning for substance use illness and any coexisting conditions.
Initiation and Engagement in Treatment
- All patients identified with alcohol use in excess of National Institute on Alcohol Abuse and Alcoholism guidelines and/or any tobacco use should receive a brief motivational counseling intervention by a health care worker trained in this technique.
Promoting Engagement in Treatment for Substance Use Illness
- Health care providers should systematically promote patient initiation of care and engagement in ongoing treatment for substance use illness. Patients with substance use illness should receive supportive services to facilitate their participation in ongoing treatment.
- Supportive pharmacotherapy should be available and provided to manage the symptoms and adverse consequences of withdrawal, based on a systematic assessment of the symptoms and risk of serious adverse consequences related to the withdrawal process. Withdrawal management alone does not constitute treatment for dependence and should be linked with ongoing treatment for substance use illness.
Therapeutic Interventions to Treat Substance Use Illness:
- Empirically validated psychosocial treatment interventions should be initiated for all patients with substance use illnesses.
- Pharmacotherapy should be recommended and available to all adult patients diagnosed with opioid dependence and without medical contraindications. Pharmacotherapy, if prescribed, should be provided in addition to and directly linked with psychosocial treatment/support.
- Pharmacotherapy should be offered and available to all adult patients diagnosed with alcohol dependence and without medical contraindications. Pharmacotherapy, if prescribed, should be provided in addition to and directly linked with psychosocial treatment/support.
- Pharmacotherapy should be recommended and available to all adult patients diagnosed with nicotine dependence (including those with other substance use conditions) and without medical contraindications. Pharmacotherapy, if prescribed, should be provided in addition to and directly linked with brief motivational counseling.
Continuing Care Management of Substance Use Illness
- Patients with substance use illness should be offered long-term, coordinated management of their care for substance use illness and any coexisting conditions, and this care management should be adapted based on ongoing monitoring of their progress.
The NQF workshop also identified six practices that have been shown to be ineffective treatments for substance use disorders, and which should not be routinely covered as part of treatment. They include:
- The use of acupuncture, relaxation therapy, didactic group education, or biological monitoring of substance use as a stand-alone treatment
- Detoxification as a stand-alone treatment for dependence
- Individual psychodynamic therapy
- Unstructured group therapy
- Confrontation as a principal approach to treatment
- Discharge from treatment in response to relapse.
The full NQF report “National Voluntary Consensus Standards for the Treatment of Substance Use Conditions: Evidence-Based Treatment Practices“can be found here: http://www.rwjf.org/pr/product.jsp?id=20611
For more information on the NQF and its work, see their website: www.qualityforum.org