Concurrent (Dual) Disorder Management Guidelines: Systematic Review Update

Background/Objectives: The initial systematic review of "Concurrent Disorder Management Guidelines. Systematic Review" assessed the quality of the concurrent disorders' clinical management guidelines in 2020, including the guidelines in the field from 2000 to 2020. Twenty-four guidelines were identified and assessed with AGREE II (Appraisal of Guidelines for Research and Evaluation). As dual disorder needs increased specifically among the younger population, requiring significant healthcare resources, more efficient approaches targeting complex concurrent disorders are essential. Since 2020, multiple new guidelines have been developed in response to new developments in the field of substance use disorder management. This systematic review update aimed to identify and appraise all new available concurrent disorder management guidelines to strategize the management of concurrent disorders, support better outcomes and further research directions. Methods: The review was registered, and protocol is available in the international register-PROSPERO. Literature searches were performed by two independent authors in electronic databases and the gray literature. The inclusion criteria were English language clinical management guidelines for adult concurrent disorders between 2020 and 2025. Sources that were not formal clinical guidelines, not addressed to physicians for adult age group, addressed to intellectual/developmental disability, or written in languages other than English were excluded. Results: The initial search resulted in 5003 records. A total of eight new guidelines were identified and assessed with AGREE II, highlighting the consistent gap in the evidence-based management recommendations. Conclusions: The appraised guidelines had similar quality to the 2020 findings, supporting dual or combined treatment; however, all guidelines had multiple domains not developed rigorously and with methodological limitations. Levels of complexity and staging of treatment were not considered in recommendations. Average domain scores were very low, with the lowest being applicability and editorial independence. Development of high-quality, rigorously developed, evidence-based guidelines, addressing staging, resource implications, and patient involvement is recommended as the evidence base remains underdeveloped.