Department of Veterans Affairs, Department of Defense. VA/DoD Management of Substance Use Disorders. VA/DoD Clinical Practice Guidelines . 2015. Available at: Accessed on: 2017-02-21.

SAMHSA accepts applications from eligible NPs & PAs who have completed a total of 24 hours of qualifying waiver training. Once you have completed both parts of the waiver training activity (available across three websites), you may begin the waiver application by Qualify for Nurse Practitioners (NPs) and Physician Assistants (PAs) Waiver. Upon your completion of the waiver training activity, Clinical Tools Inc. will send your name to SAMHSA to corroborate that you have completed the training.

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Centers for Disease Control and Prevention. Current Cigarette Smoking Among Adults in the United States. Smoking and Tobacco Use. CDCP Website. Content source: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion. 2016; December 1: . Available at: Accessed on: 2017-01-09.
Babb S, Melarcher A, Schauer G, et al.. Quitting Smoking Among Adults — United States, 2000–2015. Morbidity and Mortality Weekly Report (MMWR). 2017; 65(52): 1457–1464. Available at: Accessed on: 2017-01-09.

Interventions for substance abuse and treatment may need to be individualized for different populations. Customization is based on needs and experiences, which can include mistrust, acculturation, discrimination, and family structure. Applying standard approaches in such circumstances can make diagnosis and treatment more difficult, and conversely, accommodating such circumstances can improve outcomes (USDHHS, 2016).

Racial and Ethnic Groups

Members of certain racial and ethnic groups have a relatively higher proportion of individuals who benefit from a particular form of therapy. For example, in comparison to standard therapy, Alaskan Native and American Indian populations, on average, have responded well to Dialectical Behavior Therapy (DBT) including the use of mindfulness in order to overcome addiction cravings, combined with tribal and spiritual practices from their culture (USDHHS 2016). Another difference that may be encountered in a number of cultures is a preference for an authoritarian provider. For example, some Asians may have this preference. In this case, patients may prefer less participation in decision-making.

LGBT Populations

LGBT populations (lesbian, gay, bisexual, and transgender) may be at higher risk for substance use problems and may delay entering treatment until their issues are severe (USDHHS, 2016). This may be linked to experiences with social isolation, homophobia/transphobia, family dynamics, or violence that make them more susceptible to substance use and more hesitant to seek out help when needed (USDHHS 2016). Treatment approaches should acknowledge these factors and tailor the treatment toward dealing with them alongside the substance use. CBT, social support therapy, contingency management, and motivational interviewing have all shown positive benefits when initiating addiction treatment with some LGBT populations (USDHHS, 2016).


Substance use disorder affects a high percentage of veterans; 7.1% meet the criteria (USDHHS 2016). This may be connected to their high rate of PTSD, which is a risk factor for substance misuse. PTSD and substance misuse contribute to each other and must be addressed in combination for successful treatment. Acknowledging and treating both substance misuse and PTSD within treatment results in patient improvement in both areas (USDHHS, 2016).

In Custody

Individuals within the criminal justice system are at increased risk for substance use issues. About half of the prison population in the United States has a substance use disorder (USDHHS, 2016). Compounding the issue is that fact that these populations undergo enforced abstinence while in prison, which often leads to untreated withdrawal. Being in custody also lowers tolerance for addictive substances and thus increases the risk of overdose when released (USDHHS, 2016). In summary, this at-risk group needs specialized care to ensure they receive appropriate treatment while incarcerated as well as have a good base of recovery when released.

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USDHHS. Facing Addiction in America. The Surgeon General's Report on Alcohol, Drugs, and Health. Surgeon General Reports. 2016. Available at: Accessed on: 2016-11-17.
Substance Abuse and Mental Health Services Administration. Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder: Review and Update. Advisory. Winter 2016; 15 (1): . Available at: Accessed on: 2016-03-05.


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