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What is the most effective way to treat substance-abuse disorders? Until last December, one guess was as good as another. That was when the National Quality Forum (NQF) published a set of seven evidence-based treatment practices it found effective in treating substance-use disorders, or SUDs. The NQF document also lists common barriers to the adoption of evidence-based treatment practices.
The NQF recommendations grew out of a December 2004 conference. "It is good for pharmacists to learn more about substance-abuse disorders and treatments that work," said Marcie Bough, Pharm.D., senior manager, practice development & research, American Pharmacists Association (APhA). "It is part of the movement toward the greater utilization of evidence-based care, which will improve the overall quality of treatment for patients."
The key word is implementing. "Many pharmacists don't have a clue about substance-abuse disorders or their treatment," said addiction specialist Merrill Norton, R.Ph., counselor at the Metro Atlanta Recovery Residence, a treatment program in Atlanta. "Best practices are a step in the right direction, but pharmacy is a very conservative profession. It's going to take concerted effort from APhA and ASHP to put this on the front burner."
NQF is "very much moving in the right direction," Norton said. "But many states are cutting treatment funding and treatment days, making effective treatment even more difficult." NQF noted that only a fraction of the spectrum of SUD treatment is validated or supported by rigorous evidence in the current medical literature. But the panel was able to identify seven practices with enough scientific support to merit widespread adoption:
"Comorbidities are a real issue in substance-abuse treatment," Norton said. For example, sleep problems, common during SUD treatment, are often associated with anxiety disorder or obsessive compulsive disorder. Many physicians prescribe a sleep aid such as Ambien (zolpidem, Sanofi Aventis) without recognizing the potential to create a dynamic that leads the patient toward relapse. "We don't lack information," Norton said. "We just have a lot of misinformation. That's the real value of evidence-based treatment." The panel also found a list of treatments that do not work and should not be routinely provided. Treatments to avoid include:
A best practices summary can be found at http://www.qualityforum.org/txSUDforweb.pdf.