Substance Use

Diagnosis, treatment, and harm reduction for alcohol, opioid, and other substance use disorders. Screening instruments live on the Screening Tools page.

Society guidelines

• ASAM National Practice Guideline (Opioid Use Disorder, 2020 focused update) — American Society of Addiction Medicine; primary US OUD reference.
• ASAM Criteria (Levels of Care) — treatment placement criteria; the standard framework for level-of-care decisions.
• VA/DoD Clinical Practice Guideline for Substance Use Disorders 2021 — evidence-graded across substances; free PDFs.
• AAP Substance Use Screening, Brief Intervention, and Referral to Treatment — Levy, Williams et al, Pediatrics 2016; adolescent-focused SBIRT guidance.

SAMHSA TIPs (Treatment Improvement Protocols)

• TIP series index — consensus-developed protocols; free.
• TIP 63 — Medications for Opioid Use Disorder — buprenorphine, methadone, naltrexone.
• TIP 49 — Incorporating Alcohol Pharmacotherapies into Medical Practice — naltrexone, acamprosate, disulfiram.
• TIP 45 — Detoxification and Substance Abuse Treatment — withdrawal management protocols.

CDC guidance

• CDC Clinical Practice Guideline for Prescribing Opioids — 2022 — Dowell et al, MMWR 2022;71(RR-3); replaces 2016 guideline.
• Tapering Opioids Clinical Practice Guide (CDC/HHS) — how to safely de-prescribe chronic opioids.

Buprenorphine prescribing

• SAMHSA Buprenorphine Practitioner Resources — since 2022 MAT Act, the DEA waiver is no longer required (X-waiver eliminated); registration via standard DEA only.
• PCSS Mentoring Program — Providers Clinical Support System; SAMHSA-funded clinical mentoring on MOUD.
• Buprenorphine Use in the ED (ACEP) — ED-initiated buprenorphine protocol.

Withdrawal scoring

• CIWA-Ar (Alcohol Withdrawal, MDCalc) — 10-item alcohol withdrawal severity score; Sullivan 1989 Br J Addict.
• COWS (Clinical Opioid Withdrawal Scale, MDCalc) — Wesson & Ling 2003 J Psychoactive Drugs; threshold for bupe induction.
• PAWSS (Prediction of Alcohol Withdrawal Severity, MDCalc) — Maldonado et al; pre-detox risk stratification for complicated withdrawal.
• Finnegan Neonatal Abstinence Score (MDCalc) — neonatal opioid withdrawal severity.

Harm reduction

• Harm Reduction Coalition Resources — peer-reviewed naloxone training and safer-use materials.
• Next Distro — mail-order naloxone distribution.

Tobacco

• USPSTF Tobacco Cessation — Grade A behavioral + pharmacotherapy.
• PHS Clinical Practice Guideline — Treating Tobacco Use & Dependence (2008, still operative) — AHRQ-archived; 5 A’s framework.
• SmokefreeTXT — NIH-developed text-based quit support; multiple population-specific programs.

Cannabis

• AAP Clinical Report — Marijuana Use During Pregnancy and Breastfeeding — Ryan et al, Pediatrics; perinatal counseling.
• NIDA Cannabis Research Reports — evidence summaries on cannabis use.