New BAP guidelines target treatment of substance abuse, addiction

The British Association for Psychopharmacology (BAP) has released fresh guidelines on the best methods to treat substance abuse and addiction in the Journal of Psychopharmacology, published by SAGE. A panel of experts has carefully researched the new, comprehensive guidelines, offering practitioners a detailed review of the evidence to help them optimise their clinical decisions.

The new BAP guidelines target treatment of substance abuse, harmful use, addiction and comorbidity with psychiatric disorders, and primarily focus on pharmacological management. They represent a substantial revision of the first BAP evidence-based guidelines for "the pharmacological management of substance misuse, addiction and comorbidity," which were published in 2004. The new guidelines also take into account a number of recent documents from the UK National Institute for Health and Clinical Excellence (NICE), and other organisations.

The expert panel behind the updated guidelines searched for new evidence to offer practitioners recommendations based on the most respected and relevant research in the field. They considered pharmacological management of alcohol, nicotine, opioids, benzodiazepines, stimulants, and associated co-morbidity with mental health problems and substance use or abuse in pregnancy. The experts also reviewed the latest research into pharmacotherapy for younger and older people, those with personality disorder, and addressed 'club drugs,' cannabis and polydrug users. As well as pharmacotherapies in common clinical use, the panel also covers those with limited but promising evidence, and highlights important areas of 'key uncertainty'.

The new guidelines detail pharmacological interventions targeting the following areas:

• withdrawal syndromes
• relapse prevention and abstinence maintenance
• reducing harms associated with illicit drug use by prescribing a substitute drug or drugs (e.g. methadone maintenance treatment)
• preventing substance use complications (e.g. use of thiamine to prevent Wernicke's encephalopathy and Korsakoff's syndrome).

"Our aim is to provide helpful and pragmatic guidelines for clinicians such as psychiatrists and GPs involved in prescribing to people with substance abuse or harmful use alone and with psychiatric comorbidity," says Anne Lingford-Hughes of Imperial College, London, lead author of these guidelines, who also co-authored the original 2004 BAP guidelines. "The update should also be of interest to other practitioners in the substance misuse field, non-specialists, patients and their families," she adds.