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National Quality Forum Issues First Consensus Standards for the Treatment of Substance Use Conditions

WASHINGTON, Sept. 19 /PRNewswire-USNewswire/ -- Recognizing the devastating toll substance use conditions take on our nation's health, the National Quality Forum (NQF) today, for the first time ever, released a groundbreaking set of endorsed national voluntary consensus standards on evidence-based practices to treat substance use conditions. The standards were developed with support from the Robert Wood Johnson Foundation.

Substance use problems and illnesses have substantial impact on health and societal costs, and often are linked to catastrophic personal consequences. Data from the 2005 National Survey on Drug Use and Health reveal that an estimated 22.2 million persons aged 12 or older met diagnostic criteria for substance dependence or abuse with alcohol or illicit drugs in the past year, and an estimated 71.5 million used a tobacco product within the previous month(1).

"We cannot effectively address the disturbing effects of excessive drug and alcohol use without quality treatment for people with substance use conditions," said Janet Corrigan, PhD, NQF President and CEO. "NQF believes these standards will accelerate the use of effective, evidence-based treatments."

During the past 15 years, scientific knowledge about evidence-based therapies to treat people with substance use conditions has increased substantially. The NQF consensus standards provide clear guidance to the field on evidence-based practices that if adopted in all health care settings would substantially improve patient outcomes. The NQF report also identifies areas where further research is needed to identify preferred treatment practices and provides recommendations for the development of quality measures to evaluate and improve performance.

The endorsement of these practices by NQF's over 365 member organizations, which include healthcare providers, consumer groups, professional associations, purchasers, federal and state agencies, research and quality improvement organizations and suppliers, is the first time formal consensus has been achieved in the field about the treatment of substance use conditions. The standards were vetted through NQF's formal Consensus Development Process, with multiple stakeholder input, to achieve special legal standing as voluntary consensus standards.

"These consensus standards represent a defining leap forward in the effort to improve treatment of substance use conditions," said Elaine Cassidy, PhD, MSEd, program officer at the Robert Wood Johnson Foundation. "They give visibility and credibility to evidence-based treatment practices and create momentum for further advances."

The eleven newly endorsed treatment practices are organized into four domains and subdomains as follows:

Identification of Substance Use Conditions

Screening and Case Finding

1. During new patient encounters and at least annually, patients in

general and mental healthcare settings should be screened for at-risk

drinking, alcohol use problems and illnesses, and any tobacco use.

2. Healthcare 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

3. 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


Initiation and Engagement in Treatment

Brief Intervention

4. 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 healthcare worker trained in this technique.

Promoting Engagement in Treatment for Substance Use Illness

5. Healthcare 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.

Withdrawal Management

6. 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

Psychosocial Interventions

7. Empirically validated psychosocial treatment interventions should be

initiated for all patients with substance use illnesses.


8. 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


9. 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


10. 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

11. 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.

Seven new recommendations to accompany the practice set were likewise endorsed. The recommendations pertain to the following areas:

-- Improving the NQF-endorsed Practices

-- Additional Research

-- Measure Development

-- Implementation

-- Finance

-- Legal and Regulatory

-- Management in Primary Care

For more information and to order the report please visit:

The mission of the National Quality Forum is to improve the quality of American healthcare by setting national priorities and goals for performance improvement, endorsing national consensus standards for measuring and publicly reporting on performance, and promoting the attainment of national goals through education and outreach programs. NQF, a non-profit organization ( with diverse stakeholders across the public and private health sectors, was established in 1999 and is based in Washington, DC.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. Helping Americans lead healthier lives and get the care they need -- the Foundation expects to make a difference in our lifetime. For more information, visit

(1) Substance Abuse and Mental Health Services Administration. Office of Applied Studies. State Estimates of Substance Use from the 2003-2004 National Surveys on Drug Use and Health. Available at: Accessed August, 2006

SOURCE National Quality Forum
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