• Michigan Quality Improvement Consortium. Screening, diagnosis and referral for substance use disorders. Southfield (MI): Michigan Quality Improvement Consortium; 2007 Aug. 1 p.

This is the current release of the guideline.

This guideline updates a previous version: Michigan Quality Improvement Consortium. Screening and management of substance use disorders. Southfield (MI): Michigan Quality Improvement Consortium; 2005 Aug. 1 p.

The level of evidence grades (A-D) are provided for the most significant recommendations and are defined at the end of the "Major Recommendations" field.

Adolescents and Adults

Detection/Screening

• Screen by history for substance use at every health maintenance exam or initial pregnancy visit (repeat as indicated), using a validated screening tool (improves accuracy of detecting alcohol abuse or dependence)* [D].
• Maintain high index of concern for substance use in persons with:
  • Family history of substance use disorder [B]
  • Recent stressful life events and lack of social supports
  • Chronic pain or illness, trauma
  • Mental illness (e.g., depression, bipolar disorder, etc.)
  • Drug-seeking behaviors
  • Physical and cognitive disabilities
  • Started alcohol use before age 15
  • Medical condition associated with substance use

*Validated tools include: Alcohol Use Disorders Identification Test (AUDIT), TWEAC (for pregnant women), Michigan Alcohol Screening Test (MAST, MAST-Geriatric [MAST-G]), CAGE Survey, and Substance Abuse Subtle Screening Inventory (SASSI).

Substance dependence or abuse indicates a maladaptive pattern of substance use resulting in clinically significant impairment or distress. Relevant issues include:

• Recurrent substance use resulting in a failure to fulfill major role obligations
• Recurrent substance use in situations that are physically hazardous
• Recurrent substance-related legal problems
• Substance use despite having persistent or recurrent social or interpersonal problems
• Tolerance, withdrawal, use in larger amounts or over a longer period than intended
• Persistent desire or unsuccessful efforts to cut down
• Great deal of time spent in obtaining, using, or recovering from use of the substance
• Reduction in social, occupational, or recreational activities because of substance use
• Substance use continues despite knowledge of problems

Patients with Substance Use Disorder

Patient Education and Brief Intervention by Primary Care Physician (PCP) or Trained Staff (e.g., RN, MSW) [A]

• Assess patient's risk, understanding, and readiness to change.
• Discuss the relationship of substance use to presenting medical concerns or psychosocial problems.
• Negotiate goals and strategies for reducing consumption and other change.
• Involve family members as appropriate.

Referral Considerations

• Consider referral to community-based services (e.g., Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous) or Employee Assistance Program, or (especially if substance dependent) a substance abuse or behavioral health specialist. [D]
• Pharmacologic management should be conducted by or in collaboration with physicians who have expertise in the area of substance use disorders. [D]
• Schedule appropriate follow-up within 30 days to re-assess and support behavior change

Definitions:

Levels of Evidence for the Most Significant Recommendations

1. Randomized controlled trials
2. Controlled trials, no randomization
3. Observational studies
4. Opinion of expert panel

None provided

• Michigan Quality Improvement Consortium. Screening, diagnosis and referral for substance use disorders. Southfield (MI): Michigan Quality Improvement Consortium; 2007 Aug. 1 p.

2003 Aug (revised 2007 Aug)

Michigan Quality Improvement Consortium - Professional Association

Michigan Quality Improvement Consortium

Michigan Quality Improvement Consortium Medical Director's Committee

Physician representatives from participating Michigan Quality Improvement Consortium health plans, Michigan State Medical Society, Michigan Osteopathic Association, Michigan Association of Health Plans, Michigan Department of Community Health and Michigan Peer Review Organization

Standard disclosure is requested from all individuals participating in the Michigan Quality Improvement Consortium (MQIC) guideline development process, including those parties who are solicited for guideline feedback (e.g. health plans, medical specialty societies). Additionally, members of the MQIC Medical Directors' Committee are asked to disclose all commercial relationships.

This is the current release of the guideline.

This guideline updates a previous version: Michigan Quality Improvement Consortium. Screening and management of substance use disorders. Southfield (MI): Michigan Quality Improvement Consortium; 2005 Aug. 1 p.

None available

This NGC summary was completed by ECRI on April 14, 2004. The information was verified by the guideline developer on July 27, 2004. This NGC summary was updated by ECRI on November 28, 2005. The updated information was verified by the guideline developer on December 19, 2005. This NGC summary was updated by ECRI Institute on March 4, 2008. The updated information was verified by the guideline developer on March 12, 2008.

This NGC summary is based on the original guideline, which may be reproduced with the citation developed by the Michigan Quality Improvement Consortium.