December 2015 Page 1 of 7 

VA/DoD CLINICAL PRACTICE GUIDELINE FOR 

THE MANAGEMENT OF SUBSTANCE USE 

DISORDERS

Department of Veterans Affairs

Department of Defense

Patient Guide

QUALIFYING STATEMENTS

The Department of Veterans Affairs and the Department of Defense guidelines are based upon the best 

information available at the time of publication. They are designed to provide information and assist 

decision making. They are not intended to define a standard of care and should not be construed as one. 

Neither should they be interpreted as prescribing an exclusive course of management. 

This Clinical Practice Guideline is based on a systematic review of both clinical and epidemiological 

evidence. Developed by a panel of multidisciplinary experts, it provides a clear explanation of the logical 

relationships between various care options and health outcomes while rating both the quality of the 

evidence and the strength of the recommendation. 

Variations in practice will inevitably and appropriately occur when clinicians take into account the needs of 

individual patients, available resources, and limitations unique to an institution or type of practice. Every 

healthcare professional making use of these guidelines is responsible for evaluating the appropriateness of 

applying them in the setting of any particular clinical situation.

These guidelines are not intended to represent TRICARE policy. Further, inclusion of recommendations for 

specific testing and/or therapeutic interventions within these guidelines does not guarantee coverage of 

civilian sector care. Additional information on current TRICARE benefits may be found at www.tricare.mil 

or by contacting your regional TRICARE Managed Care Support Contractor. 

Version 3.0 – 2015
VA/DoD Clinical Practice Guideline for the Management of Substance Use Disorders

December 2015 Page 2 of 7 

I. Substance Use Disorders

• A substance use disorder develops when a person uses alcohol or another substance (for

example, illicit drugs) in a harmful way. A person with a substance use disorder may have

cravings and urges to use addictive substances even though they have problems in their life

when using these substances. These problems may include conflicts with family or friends,

issues at work, or trouble with money or law enforcement.

• Treatment can help patients prevent and treat substance use disorders and manage their

conditions to improve the quality of their lives.

Did You Know?

 In 2014, about 8% of people in the United States were affected by a substance use disorder in the last year. 

Over 6% were affected by alcohol use disorder and almost 3% were affected by a drug use disorder.[1] 

 A substance use disorder can be a life-threatening condition. Alcohol and other substance use are one of the 

leading causes of death [2] and disability [3] in the United States. 

 Patients may go back to using addicting substances, or relapse, even if they are following their treatment plan and

seem to be managing their condition. This may mean that a change needs to be made in the treatment plan.[4] 

A. What Causes a Substance Use Disorder?

Addictive substances change the way the brain works, especially the parts of the brain that encourage

activities that are important for survival such as eating, drinking water, and connecting with others. 

Normally, a person’s brain allows him or her to remember the activities, people, places, and things that 

caused these pleasurable experiences. This allows a person to repeat important activities in the future. The 

brain also associates pleasure with the use of addictive substances. With repeated substance use, a person 

values using the substance over doing more important things, even though the amount of the substance 

has to increase to achieve the same level of pleasurable effect. This need for more substance to achieve 

the same effect is known as tolerance. A person with tolerance may feel compelled to keep using a 

substance just to avoid withdrawal sickness. When a person continues to use a substance despite 

significant substance-related problems, he or she may have developed a substance use disorder.[5,6] 

B. How is a Substance Use Disorder Diagnosed?

Your provider (which may be a doctor, physician assistant, nurse practitioner, or other health care 

provider) can help you determine whether or not you have a substance use disorder. 

II. Treatment

A. What are Possible Goals of Substance Use Disorder Treatment?

Your provider will work with you to define your goals and develop your individual treatment plan. The 

overall goals of treating your substance use disorder are to promote recovery and improve your quality 

of life. 
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Goals of Substance Use Disorder Treatment [7] 

 Stop the harmful use of addictive substances

 Improve health and wellness

 Live a self-directed life

 Strive to reach full potential

 Improve quality of life

B. What are the Options for Substance Use Disorder Treatment?

There are multiple treatment options for substance use disorders that can help you reach your goals. No 

single treatment is right for everyone. By talking with your provider, you can learn more about the possible

treatment options and decide which ones are best for you. 

a. Treatment Setting

By talking with your provider, you can help pick the best treatment setting for you. You may want to be 

treated in a specialty clinic for substance use disorders, where you will have access to healthcare providers 

with special expertise and a range of treatment options. If you and your provider decide that treatment in 

a specialty clinic is not right for you, you may be treated in a primary care or general mental health clinic. 

b. Medication

Medications help treat alcohol use disorder, tobacco use disorder, and opioid use disorder, but 

medications are not used for all substance use disorders. 

There are multiple choices of medications for alcohol use disorder, tobacco use disorder, and opioid use 

disorder. You and your provider will work together to select a medication that is right for you. More 

information is available in the handout that can be found at the following link: 

http://www.healthquality.va.gov/guidelines/MH/sud/SUDTool3PatientBookletFinalHiRes.pdf. 

Along with the medication, some type of talk therapy may help. There are many types of talk therapy or 

counseling that may be helpful. Talk therapy is described below.

c. Talk Therapy

There are many different types of talk therapy which help with substance-related problems. For instance, 

talk therapy can help you see how substance use relates to other health conditions and to decide whether 

it makes sense to reduce or stop your substance use. For those who choose to stop using harmful 

substances, talk therapy can teach skills to avoid relapse. It can also help you get outside support and help 

teach your friends and family how to support your recovery.[8] 

Talk therapy has been shown to reduce harmful substance use and to improve health and quality of life. 

Each type of therapy is different. You and your provider will work together to select the therapy that will 

work best for you. 
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III. Questions to Ask Your Provider

• I drink/use drugs, but I am not sure if my substance use is a problem. How do I know if I have

a substance use disorder?

You can complete a screening questionnaire that may provide some information on your degree of

risk. You can also see a provider who can help you determine if your substance use is a problem.

• Where, when, and how is a substance use disorder diagnosed?

A provider will do an assessment and see if your substance use fits the description of a substance

use disorder. A provider can do this in any treatment setting.

 You can find information on treatment programs at this link:

https://findtreatment.samhsa.gov/TreatmentLocator/faces/addressSearch.jspx. You can 

also call 1-800-662-HELP (4357), or for a teletype device (TTY) call 1-800-487-4889. 

 Veterans can find information on nearby VA treatment programs at this link: 

http://www2.va.gov/directory/guide/SUD_flsh.asp?isFlash=1

 Active Duty patients can find information on nearby DoD programs at this link:

http://www.militaryonesource.mil/

• Is treatment for substance use disorders effective?

People with substance use disorders who receive treatment become healthy and substance-free

more often than people who do not receive treatment.

• What if I relapse?

As in other chronic diseases, symptoms may recur after being in remission. A patient with a

substance use disorder may experience increased cravings or go back to using addicting

substances, even though he or she is following the treatment plan and seems to be managing the

condition. At this point, it is important to work with your provider to reevaluate the treatment

plan and consider other treatment options.

• What treatment is best for me?

Treatment for substance use disorders is not “one size fits all.” No one approach is most effective

for everyone. The treatment that is best for you depends on your substance use disorder, your

characteristics, and your preferences. Talk with your provider about the right treatment for you.

• Where should I seek treatment?

Talk to your provider about the right treatment setting. This may be in a specialty clinic for

substance use disorders, in a residential program, in primary care, or in general mental health

care.
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• I’m on Active Duty. How will seeking treatment affect my career?

Seeking treatment can avoid a lot of career problems. However, a substance use-related incident

such as driving under the influence or testing positive may end one’s career very quickly.

• How long will I be in treatment?

The length of treatment varies from person to person. The length of the treatment will depend on

your treatment plan and your success in achieving your goals.

• How can programs like Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and SelfManagement and Recovery Training (SMART) Recovery help me?

Active involvement in mutual help programs like Alcoholics Anonymous, Narcotics Anonymous,

and SMART Recovery are valuable for many people as recovery support in addition to treatment.

Many people in long-term recovery continue mutual help involvement after they complete

treatment with medication and talk therapy.

• Can I involve my family and friends in my treatment?

Yes. Involving your partner, other family members, and friends in your treatment can help you stay

motivated. You can have a stronger and more successful treatment experience with their help. If

they are involved, you can also help improve communication and understanding about substance

use disorders. However, your individual relationship with each of your family members and friends

is unique. Discuss with your provider how each of your family members and friends should be

involved based on his or her role in your life.

• I have other mental health or medical conditions in addition to a substance use disorder.

What should I do?

Discuss your other health conditions with your provider and develop a treatment plan that is right

for you.

• Do I really need to stop tobacco use?

Stopping tobacco use can help improve your health and can decrease your risk of dying young.

Also, quitting tobacco use has been shown to improve the rates of quitting and staying quit from

other addictive substances.[9]
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IV. You Can Find More Information on SUD and Treatment of SUD Here:

• Department of Veterans Affairs’ page on Treatment Programs for Substance Use Problems:

http://www.mentalhealth.va.gov/substanceabuse.asp

• Substance Abuse and Mental Health Services Administration: http://www.samhsa.gov/atod

Toll-free Number: 1-877-SAMHSA-7 (1-877-726-4727)

For a teletype device (TTY): 1-800-487-4889

• National Institute on Alcohol Abuse and Alcoholism (NIAAA):

Toll-free Number: 1-800-662-HELP (4357)

For a teletype device (TTY): 1-800-487-4889

 Rethinking Drinking: http://rethinkingdrinking.niaaa.nih.gov/Default.aspx. 

 Treatment for Alcohol Problems: Finding and Getting Help: 

http://pubs.niaaa.nih.gov/publications/Treatment/treatment.htm

• Seeking Drug Abuse Treatment: Know What To Ask:

http://www.drugabuse.gov/publications/seeking-drug-abuse-treatment-know-what-toask/introduction

• Alcoholics Anonymous: http://www.aa.org/

• Narcotics Anonymous: https://www.na.org/

• SMART Recovery: http://www.smartrecovery.org/

• Smoke Free Vet: www.smokefree.gov/vet/
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V. References

1. Center for Behavioral Health Statistics and Quality. Behavioral health trends in the United States: Results from 

the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). 2015.

2. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. Mar 10

2004;291(10):1238-1245.

3. Murray CJ, Atkinson C, Bhalla K, et al. The state of US health, 1990-2010: Burden of diseases, injuries, and risk

factors. JAMA. Aug 14 2013;310(6):591-608.

4. Drugfacts: Understanding drug abuse and addiction. 2012; 

http://www.drugabuse.gov/publications/drugfacts/understanding-drug-abuse-addiction. Accessed June 15, 2015.

5. Volkow ND, Li TK. Drug addiction: The neurobiology of behaviour gone awry. Nat Rev Neurosci. Dec

2004;5(12):963-970.

6. Volkow ND, Wang GJ, Fowler JS, Tomasi D, Telang F. Addiction: Beyond dopamine reward circuitry. Proc Natl

Acad Sci U S A. Sep 13 2011;108(37):15037-15042.

7. Substance Abuse and Mental Health Services Administration. SAMHSA's working definition of recovery

updated. 2012; http://blog.samhsa.gov/2012/03/23/defintion-of-recovery-updated/#.VjDxiP7bLct. Accessed

October 28, 2015.

8. Treatment programs for substance use problems. 2015; http://www.mentalhealth.va.gov/resvatreatmentprograms.asp. Accessed October 27, 2015.

9. Prochaska JJ, Delucchi K, Hall SM. A meta-analysis of smoking cessation interventions with individuals in

substance abuse treatment or recovery. J Consult Clin Psychol. Dec 2004;72(6):1144-1156.