TIP 24:  A Guide to Substance Abuse Services for Primary Care Clinicians: Treatment Improvement Protocol (TIP) Series 24

Disclaimer

This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program. All material appearing in this volume except that taken directly from copyrighted sources is in the public domain and may be reproduced or copied without permission from the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Treatment (CSAT) or the authors. Citation of the source is appreciated.

This publication was written under contract number ADM 270-95-0013. Sandra Clunies, M.S., I.C.A.D.C., served as the CSAT Government project officer. Writers were Paddy Cook, Constance Grant Gartner, M.S.W., Lise Markl, Randi Henderson, Margaret K. Brooks, Esq., Donald Wesson, M.D., Mary Lou Dogoloff, Virginia Vitzthum, and Elizabeth Hayes. Special thanks go to Daniel Vinson, M.D., M.S.H.P., Mim J. Landry, Mary Smolenski, C.R.N.P., Ed.D., MaryLou Leonard, Pamela Nicholson, Annie Thornton, Jack Rhode, Cecil Gross, Niyati Pandya, and Wendy Carter for their considerable contributions to this document.

The opinions expressed herein are the views of the Consensus Panel members and do not reflect the official position of CSAT, SAMHSA, or the U.S. Department of Health and Human Services (DHHS). No official support or endorsement of CSAT, SAMHSA, or DHHS for these opinions or for particular instruments or software that may be described in this document is intended or should be inferred. The guidelines in this document should not be considered substitutes for individualized patient care and treatment decisions.

What Is a TIP?

Treatment Improvement Protocols (TIPs) are best practice guidelines for the treatment of substance abuse, provided as a service of the Substance Abuse and Mental Health Service Administration's Center for Substance Abuse Treatment (CSAT). CSAT's Office of Evaluation, Scientific Analysis, and Synthesis draws on the experience and knowledge of clinical, research, and administrative experts to produce the TIPs, which are distributed to a growing number of facilities and individuals across the country. The audience for the TIPs is expanding beyond public and private substance abuse treatment facilities as alcohol and other drug disorders are increasingly recognized as a major problem.

The TIPs Editorial Advisory Board, a distinguished group of substance abuse experts and professionals in such related fields as primary care, mental health, and social services, works with the State Alcohol and Other Drug Abuse Directors to generate topics for the TIPs based on the field's current needs for information and guidance.

After selecting a topic, CSAT invites staff from pertinent Federal agencies and national organizations to a Resource Panel that recommends specific areas of focus as well as resources that should be considered in developing the content for the TIP. Then recommendations are communicated to a Consensus Panel, non-Federal experts on the topic who have been nominated by their peers. This Panel participates in discussions over 5 days; the information and recommendations on which they reach consensus form the foundation of the TIP. The members of each Consensus Panel represent substance abuse treatment programs, hospitals, community health centers, counseling programs, criminal justice and child welfare agencies, and private practitioners. A Panel Chair (or Co-Chairs) ensures that the guidelines mirror the results of the group's collaboration.

A large and diverse group of experts closely reviews the draft document. Once the changes recommended by these field reviewers have been incorporated, the TIP is prepared for publication, in print and online. The TIPs can be accessed via the Internet on the National Library of Medicine's home page at the URL: http://text.nlm.nih.gov". The move to electronic media also means that the TIPs can be updated more easily so they continue to provide the field with state-of-the-art information.

While each TIP strives to include an evidence base for the practices it recommends, CSAT recognizes that the field of substance abuse treatment is evolving, and research frequently lags behind the innovations pioneered in the field. A major goal of each TIP is to convey "front-line" information quickly but responsibly. For this reason, recommendations proffered in the TIP are attributed to either Panelists' clinical experience or the literature. If there is research to support a particular approach, citations are provided.

The objective of this TIP, A Guide to Substance Abuse Services for Primary Care Clinicians, is to help physicians, nurses, physician assistants, and advanced practice nurses (nurse practitioners and clinical nurse specialists) screen their patients for substance use disorders, conduct brief interventions for patients in the early stages of problem development, and appropriately refer more severely affected patients for in-depth assessment and treatment. The TIP also gives an overview of the types of treatment available and outlines a primary care clinician's role in aftercare.

This document gives primary care clinicians specific guidance on identifying indications of substance abuse, how to broach the subject with a patient, and what screening and assessment instruments to use. It explains how to perform an office-based brief intervention in which patient and clinician set mutually agreed upon goals and "contract" to stop or cut back the alcohol or other drug use. The elements of in-depth assessments, appropriate referrals, and specialized treatment are discussed. The appendixes to the document include discussions by experts on leading pharmacotherapies for alcohol and other drugs and legal issues of patient confidentiality.

This TIP equips primary care clinicians who may not have any knowledge of the substance abuse field to address this pervasive disease. The physicians, nurses, social workers, researchers, certified alcohol counselors, program directors, and pharmacologists on the Consensus Panel pooled years of research and practice to devise recommendations that can be readily implemented in a busy primary care setting. This TIP represents another step by CSAT toward its goal of bringing national leadership to bear in the effort to improve substance abuse treatment.

Other TIPs may be ordered by contacting The National Clearinghouse for Alcohol and Drug Information (NCADI), (800) 729-6686 or (301) 468-2600; TDD (for hearing impaired), (800) 487-4889.