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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.
Alcohol use disorder (AUD) is a major public health problem in the United States. The estimated 12-month and lifetime prevalence values for AUD are 13.9% and 29.1%, respectively, with approximately half of individuals with lifetime AUD having a severe disorder. AUD and its sequelae also account for significant excess mortality and cost the United States more than $200 billion annually. Despite its high prevalence and numerous negative consequences, AUD remains undertreated. In fact, fewer than 1 in 10 individuals in the United States with a 12-month diagnosis of AUD receive any treatment. Nevertheless, effective and evidence-based interventions are available, and treatment is associated with reductions in the risk of relapse and AUD-associated mortality. The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder seeks to reduce these substantial psychosocial and public health consequences of AUD for millions of affected individuals. 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. In addition to reviewing the available evidence on the use of AUD pharmacotherapy, the guideline offers clear, concise, and actionable recommendation statements, each of which is given a rating that reflects the level of confidence that potential benefits of an intervention outweigh potential harms. The guideline provides guidance on implementing these recommendations into clinical practice, with the goal of improving quality of care and treatment outcomes of AUD.
Problem Drinking aims to bridge the gap that exists between the popular understanding of the subject and the modern, scientific account of the nature of alcohol problems.
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.
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.
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.
The Australian Guidelines for the Treatment of Alcohol Problems have been periodically developed over the past 25 years. In 1993, the first version of these guidelines, titled: ‘An outline for the management of alcohol problems: Quality assurance in the treatment of drug dependence project’ was published (Mattick & Jarvis 1993). The Australian Government commissioned an update a decade later (Shand et al. 2003) and a further edition in 2009 to integrate the Guidelines with the Australian Guidelines to Reduce Health Risks from Drinking Alcohol (National Health and Medical Research Council, NHMRC 2009; Haber et al., 2009). The present version of the Guidelines was also commissioned by the Commonwealth of Australia to remain current and integrated with the updated NHMRC consumption guidelines (2020). In order to ensure that guidelines remain relevant, the next set of guidelines should be updated in 2025, consistent with NHMRC recommendation that guidelines be updated every five years. These guidelines aim to provide up-to-date, evidence-based information to clinicians on available treatments for people with alcohol problems and are largely directed towards individual clinicians in practice, such as primary care physicians (general practitioners, nursing staff), specialist medical practitioners, psychologists and other counsellors, and other health professionals. Some chapters highlight service or system level issues that impact on clinicians and their patients. These include recommendations concerning Aboriginal and Torres Strait Islander peoples, culturally and linguistically diverse groups, stigma, and discrimination. Elsewhere, organisation capacity is implied, such as medical resources for withdrawal management where recommendations indicate use of medications. As all forms of treatment will not be readily available or suitable for all populations or settings, these guidelines may require interpretation and adaptation.
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.
No other text available today offers what The American Psychiatric Publishing Textbook of Substance Abuse Treatment can: completely updated treatment information on a broad range of substance use disorders that is consistent with the new DSM-5 classification and thus reflective of how psychiatry is practiced today. Designed for researchers and mental health professionals ranging from trainee to licensed practitioner, the book is also appropriate for a diverse array of rehabilitation settings, from inpatient to community-based treatment. Full coverage is provided on 12-step programs, as well, including the latest outcomes research. Much of the material is new to this edition: A chapter has been added on science in the treatment of substance abuse, in which the authors discuss the history of scientific intervention in substance abuse and explore what happens to the brain when addicting drugs are consumed, review animal models and imaging techniques, and discuss current progress in the science of addiction. Chapters have been added on screening and brief intervention, reflecting the development of brief screening tools and research on the efficacy of interventions, and the role of "recovery" in chronic care disease management -- specifically what the treatment models for alcohol dependence and for diabetes can effectively borrow from each other. A new chapter focuses on the treatment of alcohol intoxication and withdrawal -- the first steps in treatment of alcohol use disorder. Two chapters on marijuana -- one on the neurobiology and one addressing treatment have been added. Given the accelerating trend toward decriminalization and legalization of this substance, clinicians will find this information of increasing importance. The section on substance use issues among gay men and lesbians has been expanded to include bisexual and transgender people in recognition of increased diversity among the population. Well-structured, with topics that follow logically and many practical, treatment-oriented features, such as quick reference tables and lists of recommended readings, The American Psychiatric Publishing Textbook of Substance Abuse Treatment is a classic that will enhance the education and practice of clinicians.
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.