Occupational Medicine 2013;63:445–447
Advance Access publication 23 July 2013 doi:10.1093/occmed/kqt089
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A review of guidelines for collaboration in
substance misuse management
K. Van Royen1,5, R. Remmen1, M. Vanmeerbeek2, L. Godderis3,6, P. Mairiaux4 and L. Peremans1,7
1Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium, 2Department of General Practice/
Family Medicine, University of Liège, Liège, Belgium, 3Department of Occupational, Environmental and Insurance Medicine,
University of Leuven, Leuven, Belgium, 4Department of Occupational Health and Health Education, University of Liège,
Liège, Belgium, 5Department of Communication Studies, University of Antwerp, Antwerp, Belgium, 6Idewe, External Service
for Prevention and Protection at Work, Heverlee, Belgium, 7Department of Public Health, Vrije Universiteit Brussel, Brussels,
Correspondence to: K. Van Royen, Department of Primary and Interdisciplinary Care, University of Antwerp, Universiteitsplein,
Antwerp 2610, Belgium. Tel: +32 3 2655554; e-mail: firstname.lastname@example.org
Background Substance misuse among the working population results in increasing economic costs. General
practitioners (GPs) and occupational physicians (OPs) can play a central role in detecting and man-
aging substance misuse in the working population. Their collaboration could be critical in coordinat-
ing care, in facilitating rehabilitation and in reducing sickness absence.
To search guidelines for evidence on collaboration between GPs and OPs in substance misuse detec-
tion and management in the working population.
International guidelines regarding collaborative care for alcohol, illicit drug, hypnotic and tranquil-
lizer misuse were identified by a systematic search in the Guidelines International Network and US
National Guidelines Clearinghouse databases.
In total, 20 guidelines were considered of sufficient methodological quality, based on the criteria of
the Appraisal of Guidelines for Research and Education II instrument. Only two guidelines reported
on the OP’s role in screening and intervention for alcohol misuse.
Conclusions There is a lack of guidance on the OP’s role and on collaboration between GPs and OPs in this field.
Further study is required on their respective roles in substance misuse management, the effective-
ness of workplace interventions and the benefits of collaboration.
Collaboration; general practitioners; guidelines; occupational physicians; substance misuse.
Problematic rates of alcohol and drug use are observed
among the working population in Europe, resulting in
increasing costs for employers and a highly negative
impact on workplaces in terms of productivity losses,
absenteeism and healthcare expenditure .
General practitioners (GPs) and occupational phy-
sicians (OPs) can play a central role in detecting and
managing substance misuse in the working population
[2,3]. It has been suggested that inter-professional col-
laboration between GPs and OPs may be beneficial for
rehabilitation for work . The aim of this study was to
search for evidence on the effectiveness of collaboration
between GPs and OPs managing misuse of alcohol, illicit
drugs, tranquillizers and hypnotics and for resources and
strategies that can be used by these health professionals
Our search strategy, as presented in Figure 1, was part
of a broader search for guidelines for GPs and OPs
regarding substance misuse management in the Belgian
working population. We undertook a detailed search
for international guidelines to identify evidence on
recommendations for collaboration in substance misuse
management between GPs and OPs. Guidelines published
between 2002 and 2012 were identified using the databases
Guidelines International Network and US National
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446 OCCUPATIONAL MEDICINE
Guidelines Clearinghouse. Multiple and broad searches
were performed with MeSH Terms such as ‘Cooperative
behavior’, ‘Referral and consultation’, ‘Interdisciplinary
‘Alcohol-Related disorders’, ‘General
‘Primary Health Care’, ‘Physicians’, ‘Occupational Health
Physicians’, ‘Family Practice’, ‘Workplace’ (using the
Boolean terms ‘AND’, ‘OR’). The full search strategy is
available on request from the authors. Several guideline
development organizations’ and professional substance
misuse organizations’ websites were also screened. After
excluding many duplicates a first selection of guidelines
based on title and abstract was undertaken by two
researchers using the following eligibility criteria: guidelines
concerning the adult working population (18–65 years
old), published either in Dutch, English, French, German,
or Spanish languages and intended for GPs and/or OPs.
Guidelines were excluded if the primary focus was not on
illicit drugs, alcohol misuse, tranquillizers or hypnotics.
Guidelines were further assessed on quality by two
independent researchers using the Appraisal of Guidelines
for Research and Education (AGREE) II instrument .
The appraisal scores for the methodological procedure of
the guideline development were given the highest weight.
Finally guidelines with a methodology score of >50% were
included. An additional search for studies published after
the latest guideline yielded no results. No ethical approval
was required since no human subjects were involved.
A total of 5099 citations were found. After exclusions, 35
guidelines were assessed of which 20 eligible guidelines
were screened on full text for ‘collaboration’ between OPs
and GPs. Two guidelines included recommendations for
OPs [3,6] but these only concerned alcohol misuse. These
guidelines suggest that in cases where harmful alcohol use
is identified the subject should be referred to clinicians
with expertise in diagnosis and management of alcohol
misuse. Motivational communication by the OP towards
the employee is essential . However, no recommenda-
tion was made on how care should be further coordinated.
In Australia, it has been recommended that screening
and interventions should be introduced in workplaces
where the risk of alcohol misuse is high , and further
that this should be accompanied by other intervention
strategies. This recommendation was based on expert
opinion only, as there is a lack of adequate studies on the
effectiveness of screening and brief interventions in the
workplace [3,6] and therefore the OP’s role in substance
misuse management is currently undefined .
Despite the high number of guidelines that were initially
identified, our results indicated a lack of evidence about
the role of the OP in substance misuse management.
There was also a lack of evidence on collaboration with
other health professionals in substance misuse among
working people; similarly data were lacking concerning
effective ways to manage substance misuse in the occupa-
tional setting. In the light of the potential negative impact
of substance misuse on working conditions it is in our
view important to address this research gap.
Initiatives are being implemented to improve the
collaboration between these two professional groups .
Figure 1. Flowchart of guideline selection process.
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K. VAN ROYEN ET AL.: GUIDELINES FOR COLLABORATION IN SUBSTANCE MISUSE MANAGEMENT 447 Download full-text
It was found that most GPs and OPs expressed a desire
for better cooperation to improve the quality of care
and suggested that interaction between them could be
improved by a deeper understanding of their respective
roles, constraints and levels of influence [4,8]. Several
conditions, however, must be met to facilitate this.
Further study is needed on the role of GPs and OPs
in the detection and management of substance misuse in
the workplace. The OP faces many professional conflicts
in workplace drug testing, which has been the subject of
ethical debate , with opposing views on employees’
and employers’ rights. Moreover, occupational health
is primarily a prevention-orientated activity, involving a
range of skills required to identify, accurately assess and
devise strategies to manage and promote the health of
the working population . In the occupational set-
ting, many other stakeholders have a role, especially the
employer and management but also the trade unions.
Even though the interplay between stakeholders in sub-
stance misuse management varies widely from country to
country , depending on culture and regulations, the
OP’s role in substance misuse management would ben-
efit from a clearer definition. Qualitative research on the
views of different stakeholders may help to shed light on
the potential role of the OP. Efficient strategies for early
detection are needed and the impact of short interven-
tions on the workplace needs to be evaluated. Finally,
studies with good quality indicators testing and compar-
ing different models of collaboration between OPs and
GPs are needed.
• The role of occupational physicians in substance
misuse management remains uninvestigated and
subject to debate.
• No guidelines or publications are currently avail-
able on the effectiveness of collaboration between
general practitioners and occupational physicians
in this field.
• We recommend further study on the role of the
general practitioners and occupational physicians
in substance misuse management, the effective-
ness of workplace interventions and benefits of
collaboration between general practitioners and
This study was funded by a joint grant from Belgian
Science Policy [grant number DR/00/60]. Federal Public
Service Health, Food Chain Safety and Environment
and Federal Public Service Employment, Labour and
Conflicts of interest
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