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The Bureau of Justice Assistance (BJA), in partnership with the National Institute of Corrections (NIC), formed a collaboration with Advocates for Human Potential, Inc. (AHP), the American Society of Addiction Medicine (ASAM), and the National Commission on Correctional Health Care (NCCHC) to develop Guidelines for Managing Substance Withdrawal in Jails to support the effective management of substance withdrawal in local jails. Collectively, they worked with an expert committee (EC) of medical and criminal justice professionals, who included addiction specialists, correctional health care providers, and jail administrators, to guide the development process.

Multiphase Review Process

This was a multiphased process, ensuring the development of practical guidelines for jails (detention, holding, and lockup facilities) grounded in evidence-based practices. It is the product of the vision, expertise, and perseverance of many people and their extensive contributions.

  1. The EC reviewed the initial draft guidelines and provided feedback to the collective development team (BJA, NIC, ASAM, AHP, NCCHC).
  2. The collective development team reviewed and addressed the EC’s feedback and produced an updated draft based on the feedback received and follow-up discussions with the EC.
  3. External reviewers, consisting of clinical, corrections, and other key stakeholders reviewed the revised draft guidelines and provided feedback.
  4. The collective development team worked with the EC to review the feedback received from external reviewers to support the development of a final set of recommendation statements and accompanying narrative.
  5. A pre-publication draft was reviewed by the EC and feedback provided to produce the final guidelines.


The Guidelines for Managing Substance Withdrawal in Jails was created by using a modified RAND/UCLA Appropriateness Method (RAM). The RAM process is a deliberate approach encompassing review of existing clinical guidelines and standards, literature reviews, appropriateness and feasibility ratings, stakeholder comment and reconciliation, and document development. The process typically combines scientific evidence and clinical knowledge to determine the appropriateness of a set of clinical procedures. This process was modified for the development of these guidelines to incorporate the input of jail administration experts and others with legal expertise regarding implementation of guidelines and procedures in jail settings.

  • The guidelines development process started with a review of existing clinical guidelines for withdrawal management and recent (2011-2021) literature on withdrawal management in corrections settings.
  • The literature review was conducted to identify the most up-to-date evidence on the clinical management of substance withdrawal and implementation of withdrawal management in criminal justice settings, including published and unpublished clinical guidelines. This evidence was used by the EC to inform the development of draft recommendation statements.
  • These reviews resulted in over 700 draft recommendation statements for consideration by the EC comprised of medical and correctional professionals. The EC has been an integral and important voice in determining and shaping the content.
  • Each recommendation went through multiple rounds of ratings related to both appropriateness and feasibility. Through this consensus process the recommendation statements were narrowed down to topics the EC felt should be included in the narrative of the guidelines.
  • Then, the guidelines, which include narrative and recommendation statements, were drafted through a multi-phase review process.

A description of the full methodology can be found in Appendix B of the Guidelines for Managing Substance Withdrawal in Jails.

[1] Fitch, Kathryn, Steven Bernstein, Maria Dolores Aguilar, Bernard Burnand, Juan Ramon LaCalle, Pablo Lazaro, Mirjam van het Loo, Joseph McDonnell, Janneke Vader, and James P. Kahan, 2001, The RAND/UCLA Appropriateness Method User's Manual, California: RAND Corporation, retrieved June 20, 2022 from

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