b'health stabilization required? the guide leads physicians through a Yes/No decision tree that can help them decide what the best course is for this particular patient. Forexample,ifthephysician determinesthatthepatienthas anopioidabuseproblemand noimmediatestabilizationis required,thenextquestionis Is treatment for further evalua-tion indicated and acceptable to patient? If the answer is yes, the physiciancanofferspecialty referralormanagementinpri-mary care. If the answer is no, the physician can follow up dur-ing future visits as indicated.Forthosepatientswhoneed immediatestabilizationfrom withdrawal, the physician would refer to the second decision tree. This one is much more linear,Source: Perry C, Liberto J, Milliken C, Burden J, et. al. VA/DoD Guideline Development Group*. The Management of Substance Use Disorders: Synopsis of the 2021 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. withfewerYes/Noquestions.Ann Intern Med. 2022 Mar 22. doi: 10.7326/M21-4011. Epub ahead of print. PMID: 35313113. Itbeginswithobtainhistory, physicianexamination,mentalstatusexamina- treatment, the panel found insufficient evidence to tion, medication including over the counter, andmake any recommendations for or against. laboratory tests as indicated. Then, depending onAs always, VA and DoD preface the guidelines whether the patient needs urgent care, the algo- with the note that they are distillations of the exist-rithmasksthephysiciantoprovidewithdrawaling medical literature, and not a set-in-stone way care or go on to assess the severity of symptoms.for physicians to approach opioid abuse treatment. The one-page sheets also include several sidebarsVariations in practice will inevitably and appro-focusing on tapering strategies, pharmacologic treat- priately occur when clinicians take into account the ment, and which psychosocial interventions have theneedsofindividualpatients,availableresources, best outcomes with which substance use disorders.and limitations unique to an institution or type of One area where the VA/DoD working group foundpractice, the guidelines authors state in their intro-littleevidencetobackupanyrecommendationsduction. Every healthcare professional making use was in telehealth. While theres some evidence thatof these guidelines is responsible for evaluating the technology-based interventions were a useful addi- appropriateness of applying them in the setting of tion to alcohol use disorder treatment, they couldany particular clinical situation.not say the same for substance use disorder.1Perry C, Liberto J, Milliken C, Burden J, et. al. VA/DoD Guideline The guidelines suggest using structured, telephone- Development Group*. The Management of Substance Use Disor-based care as an adjunct to the usual care for substanceders: Synopsis of the 2021 U.S. Department of Veterans Affairs use disorders, but note that the evidence is weak. Asand U.S. Department of Defense Clinical Practice Guideline. Ann Intern Med. 2022 Mar 22. doi: 10.7326/M21-4011. Epub ahead of for computer-delivered care, smartphone apps, textprint. PMID: 35313113. andvoicemessaging,andtelemedicine-delivered 17'