Introduction

In keeping with the American Society of Addiction Medicine’s (ASAM) mission to define and promote evidence-based best practices in addiction prevention, treatment, remission, and recovery, ASAM Quality Improvement Council (QIC) sought to rigorously update and structure ASAM’s Clinical Practice Guideline (CPG) methodology. The QIC recognized a need for ASAM’s CPG methods to be more in line with international standards for CPGs such as:

• Establishing improved transparency
• Managing conflicts of interest
• Balancing guideline group composition
• Using a rigorous systematic review
• Establishing quality of evidence
• Determining the strength of recommendations
• Articulating recommendations clearly and succinctly
• Engaging stakeholder review
• Promoting diversity, equity, and inclusion · Establishing a process for CPG updates

Over a two-year process, ASAM worked to create this new methodology which will inform how future ASAM CPGs are conducted.

Methodology

In January 2021, the ASAM QIC developed the “Clinical Practice Guideline Methodology and Oversight Subcommittee” and chose Dr. Melissa Weimer to lead this subcommittee. The CPG-MOS was charged with providing strategic oversight to the development, implementation, education, and communication of CPGs. The goals of the CPG-MOS were to establish and publish a methodology for the development of CPGs and to develop a CPG strategic plan.

Through an open call process, ASAM members were invited to apply for consideration to serve on the CPG-MOS subcommittee. The seven members chosen represent individuals from diverse backgrounds, geographies, research experience, and clinical backgrounds.

Each individual CPG methodology underwent evidence review, subcommittee deliberation, and consensus. The CPG-MOS subcommittee presented all proposed methodology for review, deliberation and approval to the ASAM QIC. When needed, other ASAM committees such as the ASAM Ethics Committee were engaged for review, deliberation and approval.

In the process of CPG methodology development, it became clear that other non-CPG clinical practice documents may be relevant for ASAM to develop. To promote best practices that remain evidence-based and can be more efficiently produced, the CPG-MOS and the QIC also developed a framework for new clinical documents described here as Clinical Guidance Statements and Clinical Considerations. These clinical documents will have less methodological rigor than the CPG, but will allow ASAM to respond in a timely manner to urgent clinical concerns from its members and the public.

The ASAM CPG Methodology will be reviewed every 5 years by the QIC for updates.

Authors: Members of the ASAM Clinical Practice Guideline Methodology and Oversight Subcommittee (CPG-MOS)

Chair: Melissa B. Weimer, DO, MCR, DFASAM

Members: Emily Brunner, MD, DFASAM, Devan Kansagara, MD, Todd Korthuis, MD, MPH, FASAM, Lewis S. Nelson, MD, MBA, FASAM, Darius Rastegar, MD, FASAM, Audra Stock, MA, Carlos Tirado, MD, MPH, FASAM

ASAM Staff: Amanda Devoto, PhD, Taleen Safarian

Consultant: Bethea A. Kleykamp, PhD