The Management of Substance Use Disorders: Synopsis of the 2021 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline
Christopher Perry, Joseph Liberto, Charles Milliken, Jennifer Burden, Hildi Hagedorn, Timothy Atkinson, James R. McKay, Larissa J. Mooney, James Sall, Comilla Sasson, Andrew Saxon, Christopher Spevak, Adam J. Gordon, VA/DoD Guideline Development Group*, Christopher Perry, Joseph Liberto, Charles Milliken, Jennifer Burden, Hildi Hagedorn, Timothy Atkinson, James R. McKay, Larissa J. Mooney, James Sall, Comilla Sasson, Andrew Saxon, Christopher Spevak, Adam J. Gordon, Renee Redden, Rachael Coller, Kathleen M. Stack, Christopher Taylor, Fran Murphy, Jim Smirniotopoulos
Abstract
DESCRIPTION: In August 2021, leadership within the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) approved a joint clinical practice guideline (CPG) for the management of substance use disorders (SUDs). This synopsis summarizes key recommendations. METHODS: In March 2020, the VA/DoD Evidence-Based Practice Work Group assembled a team to update the 2015 VA/DoD Clinical Practice Guideline for the Management of Substance Use Disorders that included clinical stakeholders and conformed to the National Academy of Medicine's tenets for trustworthy CPGs. The guideline panel developed key questions, systematically searched and evaluated the literature, created two 1-page algorithms, and distilled 35 recommendations for care using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. This synopsis presents the recommendations that were believed to be the most clinically impactful. RECOMMENDATIONS: The scope of the CPG is broad; however, this synopsis focuses on key recommendations for the management of alcohol use disorder, use of buprenorphine in opioid use disorder, contingency management, and use of technology and telehealth to manage patients remotely.