Table 3.
Consideration of concurrent problems
| Guideline | Is the link between mental health and misuse of substances mentioned as part of the background? | Does the guideline mention that either SMI or SUD can worsen the outcome of another? | Does the guideline provide recommendations about Screening/Assessment for coexisting disorders? | Does the guideline mention the competence of healthcare professionals in recognition the existence of the other comorbidity (i.e. either substance misuse or mental health problems)? | Does the guideline requests healthcare professionals to seek advice or training from the other service i.e. training from substance misuse service staff to staff in mental health services? | Does the guideline specifically mention not to exclude patients who misuse substance from age-appropriate treatment settings of mental illness due to use of substances? | Does the guideline specifically mention not to exclude patients who have mental illness from age-appropriate treatment setting of substance misuse due to mental health problems? | Who refers patients to a mental health setting or to the substance misuse/alcohol misuse services? | If a guideline is for mental health, does it mention not to discharge patients from inpatient services because of their substance misuse? |
|---|---|---|---|---|---|---|---|---|---|
|
NICE 2011 (coexisting disorders) [37] |
Yes | Yes | Mentioned. Suspected patients should be asked about any drugs and alcohol drinking including: its type, quantity, frequency, route of administration, and duration of use. | Yes | Yes | Yes | Yes | Mentioned. All staff who have direct contact with patients, including professionals in primary care and educational settings. | Yes |
|
NICE 2016 (coexisting disorders) [38] |
Yes | Yes | Mentioned. A Full evaluation for suspected patients. | No | Yes | Yes | No | Mentioned. All staff who have direct contact with patients, including professionals in primary care and educational settings. | No |
| Australian government 2016 [39] | Yes | Yes | Mentioned. After abstinence, a full assessment of the patient should ideally occur. | Yes | Yes | No | No | Not mentioned | Not applicable |
| SIGN 2013 [47] | Yes | Yes | Not mentioned | Yes | Yes | Yes | No | Not mentioned | No |
| NICE 2014 [48] | Yes | Yes | Not mentioned | No | Yes | No | No | Mentioned. Primary healthcare professionals | No |
| WFSBP 2015 [49] | Yes | Yes | Mentioned. Detailed assessment of substance use disorder should be obtained. | No | No | No | No | Not mentioned | No |
| RANZCP 2016 [50] | Yes | Yes | Mentioned. Any suspicions regarding the use of stimulant drugs should be raised if there are recurrent episodes of psychosis. | Yes | Yes | No | No | Mentioned. Health care professionals and any other professionals involved in providing care for patients, such as GPs and social counsellors. | No |
| BAP 2019 [51] | Yes | Yes | Mentioned. A detailed assessment of substance use disorder should be obtained. | No | No | No | No | Not mentioned | No |
| APA 2020 [52] | Yes | Yes | Mentioned. Any initial assessment of a patients with a possible psychotic disorder should include an assessment of their tobacco use and other substance misuse. | Yes | Yes | No | No | Not mentioned | No |
| VA/DoD 2010 [53] | Yes | Yes | Mentioned. A complete clinical assessment should be obtained. | No | No | No | No | Not mentioned | Yes |
| Singapore MOH 2011 [54] | Yes | Yes | Not mentioned | No | No | No | No | Not mentioned | No |
| NICE 2014 [55] | Yes | Yes | Not mentioned | No | Yes | No | No | Mentioned. Primary healthcare professionals | No |
| BAP 2016 [56] | No | Yes | Mentioned. The clinician should assess to what extent does substance misuse contribute to bipolar symptoms. | No | Yes | No | No | Not mentioned | No |
| CANMAT and ISBD 2018 [57] | Yes | Yes | Not mentioned | Yes | No | No | No | Not mentioned | No |
| BAP 2012 [40] | Yes | Yes | Mentioned. Substance history, family history, urinalysis and blood tests, as well as an assessment of psychiatric disorder onset, and the misuse of substances should be carried out. | No | No | No | No | Not mentioned | Not applicable |
| WFSBP 2017 [41] | Yes | Yes | Not mentioned | No | No | No | No | Not mentioned | Not applicable |
| gov.uk 2017 [42] | Yes | Yes | Mentioned. Identifying any current or previous psychological problems | Yes | Yes | Yes | No | Mentioned. GPs | Not applicable |
| DGPPN and DG-Sucht 2017 [43] | Yes | Yes | Mentioned. The assessment process derived from alcohol use disorder identification test guidelines | No | No | No | No | Not mentioned | Yes |
| NICE 2011 [44] | Yes | Yes | Mentioned. Patients should be referred to a psychiatrist for effective assessment and treatment. | Yes | Yes | No | No | Mentioned. Whole range of healthcare such as a GP. | Not applicable |
| APA 2018 [45] | Yes | Yes | Mentioned. Patients should be assessed for alcohol use disorder and comorbid mental health disorder. | No | No | No | No | Not mentioned | No |
| ASAM 2015 [46] | Yes | Yes | Mentioned. A comprehensive assessment of the patient and any ideas related to suicide should be evaluated. The patient’s full medical history and a physical examination should also be obtained. | Yes | Yes | No | No | Not mentioned | Not applicable |
AOD Alcohol and other drug, APA American Psychiatric Association, ASAM American society of addiction medicine, AUD alcohol use disorder, BAP British Association of psychopharmacology, CANMAT and ISBD Canadian Network for Mood and Anxiety Treatments and International Society for Bipolar Disorders, gov.UK United Kingdom guidelines on clinical management, GPs General practitioners, DGPPN and DG-Sucht German Association for Psychiatry, Psychotherapy, and Psychosomatics and the German Association for Addiction Research and Therapy, NICE National Institute for Health and Care Excellence, RANZCP Royal Australian and New Zealand College of Psychiatrists, SIGN Scottish Intercollegiate Guidelines Network, Singapore MOH Singapore Ministry of Health, SMI Severe mental illness, SUD Substance use disorder, UK United Kingdom, US United States, VA/DoD Department of Veterans Affairs and The Department of Defense, WFSBP World Federation of Societies of Biological Psychiatry