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Addressing Unhealthy Alcohol Use in Primary Care by Richard Saitz Pdf
While there is a wealth of published information on addiction medicine, the psychological aspects of alcohol abuse, and behavioral medicine with regard to addiction, virtually none of these resources were written with the primary care provider in mind. Addressing Unhealthy Alcohol Use in Primary Care is a resource for primary care clinicians who are confronted by patients with these problems daily, and who wish to successfully address these issues in their practice. It would focus on the literature and science relevant to primary care practice and cover the range of interventions appropriate for this setting. Topics include assessment, brief counseling interventions, pharmacotherapy, referrals to both specialty care and Alcoholics Anonymous (and other self-help programs), psychiatric co-morbidity and other drug use, and other information specific to the needs of the primary care provider.
This manual presents the first empirically studied, integrative treatment approach developed specifically for co-occurring PTSD and substance abuse. For persons with this prevalent and difficult-to-treat dual diagnosis, the most urgent clinical need is to establish safety--to work toward discontinuing substance use, letting go of dangerous relationships, and gaining control over such extreme symptoms as dissociation and self-harm. The manual is divided into 25 specific units or topics, addressing a range of different cognitive, behavioral, and interpersonal domains. Each topic provides highly practical tools and techniques to engage patients in treatment; teach "safe coping skills" that apply to both disorders; and restore ideals that have been lost, including respect, care, protection, and healing. Structured yet flexible, topics can be conducted in any order and in a range of different formats and settings. The volume is designed for maximum ease of use with a large-size format and helpful reproducible therapist sheets and handouts, which purchasers can also download and print at the companion webpage. See also the author's self-help guide Finding Your Best Self, Revised Edition: Recovery from Addiction, Trauma, or Both, an ideal client recommendation.
U. S. Department of Health and Human Services,Agency for Healthcare Research and Quality
Author : U. S. Department of Health and Human Services,Agency for Healthcare Research and Quality Publisher : CreateSpace Page : 384 pages File Size : 50,7 Mb Release : 2013-03-28 Category : Medical ISBN : 1483983692
Screening, Behavioral Counseling, and Referral in Primary Care to Reduce Alcohol Misuse by U. S. Department of Health and Human Services,Agency for Healthcare Research and Quality Pdf
Alcohol misuse, which includes the full spectrum from drinking above recommended limits (i.e., risky/hazardous drinking) to alcohol dependence, is associated with numerous health and social problems and more than 85,000 deaths per year in the United States and an estimated annual cost to society of more than $220 billion. Alcohol misuse is estimated to be the third leading cause of preventable mortality in the United States following tobacco use and being overweight. Alcohol misuse contributes to a variety of conditions, including hypertension, cirrhosis, gastritis and gastric ulcers, pancreatitis, breast cancer, neuropathy, cardiomyopathy, anemia, osteoporosis, cognitive impairment, depression, insomnia, anxiety, and suicide. Excessive alcohol consumption is a major factor in injury and violence. Definitions of the spectrum of alcohol misuse (i.e., unhealthy alcohol use) continue to evolve. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has proposed epidemiologically based alcohol-use guidelines to limit risks for drinking-related consequences by establishing age- and sex-specific recommended consumption thresholds. This report's main objective is to conduct a systematic review of the effectiveness of screening followed by behavioral counseling, with or without referral, for alcohol misuse in primary care settings, addressing seven questions. This new review differs from the report on which the USPSTF 2004 recommendations were based in the following ways: We allowed inclusion of screening and behavioral interventions for the full spectrum of alcohol misuse, as long as subjects were identified by screening in a primary care or primary care-like setting; we added referral as an intervention of interest and changed the title to reflect this; we expanded the eligible settings from traditional primary care to also include settings with primary care-like relationships (e.g., infectious disease clinics for people with HIV); and we added additional outcomes of interest to our inclusion/exclusion criteria and analytic framework. Key Questions addressed by this review include: KQ 1: What is the direct evidence that screening for alcohol misuse followed by a behavioral counseling intervention, with or without referral, leads to reduced morbidity, reduced mortality, or changes in other long-term (6 months or longer) outcomes (e.g., health care utilization, sick days, costs, legal issues, employment stability)? KQ 2: How do specific screening modalities compare with one another for detecting alcohol misuse? KQ 3: What adverse effects are associated with screening for alcohol misuse and screening-related assessment? KQ 4a: How do behavioral counseling interventions, with or without referral, compare with usual care for improving intermediate outcomes for people with alcohol misuse as identified by screening? KQ 4b: How do specific behavioral counseling approaches, with or without referral, compare with one another for improving intermediate outcomes for people with alcohol misuse as identified by screening? KQ 5: What adverse effects are associated with behavioral counseling interventions, with or without referral, for people with alcohol misuse as identified by screening? KQ 6: How do behavioral counseling interventions, with or without referral, compare with one another and with usual care for reducing morbidity, reducing mortality, or changing other long-term (6 months or longer) outcomes (e.g., health care utilization, sick days, costs, legal issues, employment stability) for people with alcohol misuse as identified by screening? KQ 7: To what extent do health care system influences promote or hinder effective screening and interventions for alcohol misuse?
A Guide to Substance Abuse Services for Primary Care Clinicians by Eleanor J. Sullivan Pdf
EXECUTIVE SUMMARY AND RECOMMENDATIONS: The goal of this TIP is to recommend guidelines for primary care clinicians to follow in caring for patients with alcohol and other drug use disorders. These guidelines were developed by a Consensus Panel of clinicians, researchers, and educators who work on the prevention and treatment of substance use disorders. Protocols are based partly on research evidence, partly on Panel members' clinical experience. The algorithm to the left follows a patient with substance use problems who presents in a primary care setting. The chart will serve as a guide or road map through screening, brief assessment, brief intervention, assessment, referral, specialized treatment, and followup care as they are detailed in the TIP. Since substance use disorders are often chronic conditions that progress slowly over time, primary care clinicians, through their regular, long-term contact with patients, are in an ideal position to screen for alcohol and drug problems and monitor each patient's status. Futhermore, studies have found that primary care clinicians can actually help many patients decrease alcohol consumption and its harmful consequences through office-based interventions that take only 10 to 15 minutes (Kahan et al., 1995; Wallace et al., 1988). This potential, however, is largely untapped: Saitz and colleagues found that of a sample of patients seeking substance abuse treatment, 45 percent reported that their primary care physician was unaware of their substance abuse (Saitz et al., in press). Yet even though screening and limited treatment of substance use disorders do not require a large time investment, the Consensus Panel that developed this TIP recognized that many primary care clinicians are already overwhelmed by the demands imposed by expanded gatekeeper functions. The Panel realized that a practical approach to addressing patients' substance abuse problems was needed: one that recognized the time and resource limitations inherent in primary care practice and offered a series of graduates approaches that could be incorporated into a normal clinic or office routine. Biological, medical, and genetic factors as well as psychological, social, familial, cultural, and other environmental features all bear on substance abuse. Addressing the condition effectively requires a team effort, especially when it has progressed beyond the early stage. For this reason, in addition to screening and intervention treatment options, these guidelines include information about viable referral for assessment and treatment, as well as followup. Readers will notice that the TIP contains more information on alcohol use and abuse than on use of illicit drugs. This reflects both the scope of the problems and the research literature available about them. It is estimated that about 18 million people with alcohol use problems and 5 million users of illicit drugs need treatment. Although the Panel recognizes that tobacco is an addictive substance with a major public health impact, it is not included in this TIP because the topic falls outside CSAT's purview. Readers are referred to "Smoking Cessation: a Guide for Primary Care Clinicians," published by the Agency for Health Care Policy and Research (Agency for Health Care Policy and Research, 1996). The Consensus Panel's recommendations are based on a combination of clinical experience and research-based evidence. In the list below, the summary guidelines supported by the research literature are followed by (1); clinically based recommendations are marked (2). Citations supporting the former are referenced in the body of the document. Screening and assessment instruments mentioned below are reproduced and discussed in Chapters 2 and 4 and Appendix C. The guidelines are presented in more detail in Chapter 6.
The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder by American Psychiatric Association Pdf
The guideline focuses specifically on evidence-based pharmacological treatments for AUD in outpatient settings and includes additional information on assessment and treatment planning, which are an integral part of using pharmacotherapy to treat AUD.
Substance Use and Addiction Medicine, An Issue of Medical Clinics of North America, E-Book by Jeffrey H. Samet,Patrick G O'Connor,Michael D Stein Pdf
This issue of Medical Clinics, guest edited by Drs. Jeffrey H. Samet, Patrick G. O'Connor, and Michael D. Stein, is devoted to Substance Use and Addiction Medicine. Articles in this outstanding issue include: Making Unhealthy Substance Use a Part of Behavioral Health Integration in Primary Care; The Inpatient Addiction Consult Medical Service: Expertise for Hospitalized Patients with Complex Addiction Problems; The Addiction Physician Workforce: Addiction Psychiatry and Addiction Medicine Collaboration in a New Age; Preventing Opioid Overdose in the Clinic and Hospital: Analgesia and Opioid Antagonists; The Role of Non-Traditional Maintenance Treatments: Injectable Opioid Agonist Therapies and Managed Alcohol Programs; Office-Based Addiction Treatment (OBAT) in Primary Care: Models that Work; Alcohol Use Disorder Pharmacotherapy: the Use of FDA and non-FDA Approved Medications; When and How to Treat Possible Cannabis Use Disorder; Clinical Presentations of New Drugs with Abuse Potential; Use of Technology in Addiction Therapy; Sleep Management Among Patients with Substance Use Disorders; Pain Management Among Patients with Substance Use Disorders; E-Cigarettes: A Path to Recovery or a Road to Hell?; Are Adolescent and Young Adults Different When Addressing Substance Use Disorders?; and Smoking Cessation for Those in Recovery from Substance Use Disorders.
Institute of Medicine,Board on Health Care Services,Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders
Author : Institute of Medicine,Board on Health Care Services,Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders Publisher : National Academies Press Page : 528 pages File Size : 53,8 Mb Release : 2006-03-29 Category : Medical ISBN : 9780309133661
Improving the Quality of Health Care for Mental and Substance-Use Conditions by Institute of Medicine,Board on Health Care Services,Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders Pdf
Each year, more than 33 million Americans receive health care for mental or substance-use conditions, or both. Together, mental and substance-use illnesses are the leading cause of death and disability for women, the highest for men ages 15-44, and the second highest for all men. Effective treatments exist, but services are frequently fragmented and, as with general health care, there are barriers that prevent many from receiving these treatments as designed or at all. The consequences of this are seriousâ€"for these individuals and their families; their employers and the workforce; for the nation's economy; as well as the education, welfare, and justice systems. Improving the Quality of Health Care for Mental and Substance-Use Conditions examines the distinctive characteristics of health care for mental and substance-use conditions, including payment, benefit coverage, and regulatory issues, as well as health care organization and delivery issues. This new volume in the Quality Chasm series puts forth an agenda for improving the quality of this care based on this analysis. Patients and their families, primary health care providers, specialty mental health and substance-use treatment providers, health care organizations, health plans, purchasers of group health care, and all involved in health care for mental and substanceâ€"use conditions will benefit from this guide to achieving better care.
Comprehensive Care of the Patient with Chronic Illness, An Issue of Medical Clinics of North America by Douglas S. Paauw Pdf
This issue of Medical Clinics of North America, Guest Edited by Douglas S. Paauw, MD is devoted to Comprehensive Care of the Patient with Chronic Illness. Dr. Paauw has assembled a group of expert authors to review the following topics: Primary Care of the Homeless Patient; Primary Care of the Patient with Chronic Liver Disease; Primary Care of the Transplant Patient; Primary Care of the Patient with CRI; Primary Care of the Patient with Alcoholism; Primary Care of the Childhood Cancer Survivor; Primary Care of the Immigrant Patient; Primary Care of the HIV Patient; Primary Care of the Patient with Chronic Lung Disease; Primary Care of the Patient with Sarcoid; and Primary Care of the Patient with Inflammatory Bowel Disease.
Alcohol Use: Assessment, Withdrawal Management, Treatment and Therapy by David B. Cooper Pdf
The book brings together the most up-to-date knowledge and expertise covering the whole topic of alcohol. It presents the practical skills needed to offer ethical intervention and treatment and implement ethical person-centered care. It is a practice-based text that aims to improve ethical relationships, responses, care and practice necessary to be effective in interventions and treatment with those experiencing alcohol use and health problems. The focus is on combining the principles and philosophy of alcohol prevention and intervention, in hospital and community. Each chapter provides self-assessment exercises, reflective practice exercises, key points and a "to learn more" section, and develops a theoretical framework, before broadening to include application in care and practice. This work will appeal to a wide readership, from professionals working within the mental health care and practice environment to mental health students.
Addiction Medicine: A Multidisciplinary Approach by Joel J. Heidelbaugh Pdf
The Clinics Collections titles take a multidisciplinary approach to today’s practice of medicine, selecting the most recent and relevant articles from the Clinics series and combining them into a single source of information on a focused topic. Articles are chosen from multiple Clinics to highlight the range of specialties covering major medical issues, delivering the information needed for successful interdisciplinary teamwork and effective patient care. Written from a variety of medical perspectives, these articles offer deeper insight into how each specialty cares for its patients and provide a unique entry into sharing best concepts for the entire medical team. Clinics Collections: Addiction Medicine draws from Elsevier’s Clinics Review Articles database to provide today’s medical teams with practical clinical advice and insights on this complex condition and its comorbidities. It guides readers on how to apply current primary research findings to everyday practice, keep up with new and improved treatment methods, and improve patient outcomes. Areas of focus include opioids, alcoholism, cannabis, and prescription medicine. Each article begins with keywords and key points for immediate access to the most critical information. Articles are presented in an easy-to-digest and concisely worded format.
Lifestyle Medicine by Jeffrey I. Mechanick,Robert F. Kushner Pdf
Lifestyle – the manner in which people live – is fundamental to health, wellness, and prevention of disease. It follows that attention to lifestyle is critically important to effective and successful health care. But here’s the challenge: health care professionals receive very little, if any, formal training about lifestyle counseling and therefore are ill equipped to incorporate lifestyle issues into clinical practice. In response, “Lifestyle Medicine” is evolving as a means to fill this knowledge gap. Lifestyle medicine approaches health and wellness by harnessing the power of lifestyle-related behaviors and influencing the environment we live in. It is a formal approach that promises to enhance and strengthen a re-invigorated health care system that is still outpaced by the epidemic proportions and complexity of chronic diseases like obesity, diabetes, depression, hypertension, and cancer, among others. Lifestyle Medicine: A Manual for Clinical Practice presents this formal approach in a pragmatic context. This unique and practical manual provides clear and succinct guidance on nearly all aspects of lifestyle medicine. The approach is both explanatory and pragmatic, providing case studies and bulleted translation of academic information into clinical practice recommendations. There is an emphasis on scientific evidence wherever possible as well as opinions by the expert chapter authors who practice lifestyle medicine. There is a “how-to” rationality to the book, consistent with a premise that any and all health care professionals should, and perhaps must, incorporate lifestyle medicine. A valuable checklist is included at the close of the book that summarizes key points and provides a practical tool for routine patient encounters.
National Academies of Sciences, Engineering, and Medicine,Health and Medicine Division,Board on Health Sciences Policy,Board on Health Care Services,Forum on Mental Health and Substance Use Disorders
Author : National Academies of Sciences, Engineering, and Medicine,Health and Medicine Division,Board on Health Sciences Policy,Board on Health Care Services,Forum on Mental Health and Substance Use Disorders Publisher : National Academies Press Page : 123 pages File Size : 49,5 Mb Release : 2021-01-30 Category : Medical ISBN : 9780309682688
Caring for People with Mental Health and Substance Use Disorders in Primary Care Settings by National Academies of Sciences, Engineering, and Medicine,Health and Medicine Division,Board on Health Sciences Policy,Board on Health Care Services,Forum on Mental Health and Substance Use Disorders Pdf
Behavioral health conditions, which include mental health and substance use disorders, affect approximately 20 percent of Americans. Of those with a substance use disorder, approximately 60 percent also have a mental health disorder. As many as 80 percent of patients with behavioral health conditions seek treatment in emergency rooms and primary care clinics, and between 60 and 70 percent of them are discharged without receiving behavioral health care services. More than two-thirds of primary care providers report that they are unable to connect patients with behavioral health providers because of a shortage of mental health providers and health insurance barriers. Part of the explanation for the lack of access to care lies in a historical legacy of discrimination and stigma that makes people reluctant to seek help and also led to segregated and inhumane services for those facing mental health and substance use disorders. In an effort to understanding the challenges and opportunities of providing essential components of care for people with mental health and substance use disorders in primary care settings, the National Academies of Sciences, Engineering, and Medicine's Forum on Mental Health and Substance Use Disorders convened three webinars held on June 3, July 29, and August 26, 2020. The webinars addressed efforts to define essential components of care for people with mental health and substance use disorders in the primary care setting for depression, alcohol use disorders, and opioid use disorders; opportunities to build the health care workforce and delivery models that incorporate those essential components of care; and financial incentives and payment structures to support the implementation of those care models, including value-based payment strategies and practice-level incentives. This publication summarizes the presentations and discussion of the webinars.
Unhealthy Alcohol Use in Older Adults by Erin L. Woodhead Pdf
As our population ages, practitioners find themselves working with older adults more frequently. Alcohol use problems among older adults are often underdiagnosed and undertreated, and there are few treatments designed specifically for this client group. This practical guide provides practitioners with up-to-date information on assessing and treating unhealthy alcohol use among older adults. With a focus on evidence-based treatments, it is highly relevant to practitioners working across a variety of settings. Through the author's expertise, we learn about the prevalence of alcohol use among older adults, the models for understanding unhealthy use, and the different screening and assessment options as well as the treatment possibilities relevant to health care and social service providers. Assessment and treatment options highlight the need to consider lifespan development when providing care as well as the relevance of common life transitions and generational differences. Clinical pearls and vignettes illuminate treatment approaches and further sections discuss pharmacological interventions and cultural considerations. Printable tools are available in an appendix. This book is a must for practitioners from diverse settings who work with older adults. The materials for this book can be downloaded from the Hogrefe website after registration.
Addiction, An Issue of Psychiatric Clinics - E-Book by Itai Danovitch,John J. Mariani Pdf
This completely new and updated issue takes a focused look at addiction psychiatry in three sections: Diagnostics, Therapeutics, and New Directions. Dr. Danovitch, from Cedars-Sinai and Dr. Mariani from Columbia hone in on the most rapidly advancing and relevant areas of addiction for practitioners today, from defining addiction (implications of DSM-V), to genetics and neurobiology, to specific treatment options for a variety of patient populations: for pregnant women, adolescents, and patients suffering from chronic pain, for example. A variety of addiction types are discussed (ie, opioid, stimulant, and cannabis). The issue closes with discussions of emerging trends, systems of care, investigational therapeutics and the role of the criminal justice system.
