Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + ALCOHOL ABUSE AND DEPENDENCE Download Section PDF Listen +++ +++ Population ++ –Adults older than 18 y of age. +++ Recommendations ++ CDC 2018, USPSTF 2013, ASAM 1997 ++ –Screen all adults in primary care settings, including pregnant women, for alcohol misuse. –Provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse. –Provide brief intervention to those who have a positive alcohol misuse screen now and during future visits. ++ Sources ++ –CDC. Alcohol Screening and Brief Intervention for People Who Consume Alcohol and Use Opioids. 2018. –USPSTF. Alcohol Misuse: Screening and Behavioral Counseling in Primary Care. 2013. –ASAM. Public Policy Statement on Screening for Addiction in Primary Care Settings. 1997. +++ Comments ++ Screen regularly using a validated tool such as the AUDIT, CAGE, or MAST questionnaires. The TWEAK and the T-ACE are designed to screen pregnant women for alcohol misuse. +++ Population ++ –Children and adolescents. +++ Recommendation ++ USPSTF 2013 ++ –Insufficient evidence to recommend for or against screening or counseling interventions to prevent or reduce alcohol misuse by adolescents. ++ Source ++ –USPSTF. Alcohol Misuse: Screening and Behavioral Counseling Interventions in Primary Care. 2013. +++ Comments ++ Screen using a tool designed for adolescents, such as the CRAFFT, BSTAD, or S2BI. Reinforce not drinking and driving or riding with any driver under the influence. Reinforce to women the harmful effects of alcohol on fetuses. + DEPRESSION Download Section PDF Listen +++ +++ Population ++ –Children aged 11 y and younger. +++ Recommendation ++ USPSTF 2016 ++ –Insufficient evidence to recommend for or against routine screening. ++ Source ++ –USPSTF. Depression in Children and Adolescents: Screening. 2016. +++ Population ++ –Adolescents. +++ Recommendation ++ USPSTF 2016 ++ –Screen all adolescents age 12–18 y for major depressive disorder (MDD). Systems should be in place to ensure accurate diagnosis, effective treatment, and adequate follow-up. ++ Source ++ –USPSTF. Depression in Children and Adolescents: Screening. 2016. +++ Comments ++ Screen in primary care clinics with the Patient Health Questionnaire for Adolescents (PHQ-A) (73% sensitivity; 94% specificity) or the Beck Depression Inventory-Primary Care (BDI-PC) (91% sensitivity; 91% specificity). See Chapter 39. Treatment options include pharmacotherapy (fluoxetine and escitalopram have FDA approval for this age group), psychotherapy, collaborative care, psychosocial support interventions, and CAM approaches. SSRI may increase suicidality in some adolescents, emphasizing the need for close follow-up. +++ Population ++ –Adults. +++ Recommendation ++ USPSTF 2016 ++ –Recommend screening adults for depression, including pregnant and postpartum women. Have staff-assisted support systems in place for accurate diagnosis, effective treatment, and follow-up. ++ Source ++ –USPSTF. Depression in Adults: Screening. 2016. +++ Comments ++ PHQ-2 is as sensitive (96%) as longer screening tools: “Over the past 2 wk, have you felt down, depressed, or hopeless?” “Over the past 2 wk, have you felt little interest or pleasure in doing things?” Optimal screening interval is unknown. + ILLICIT DRUG USE Download Section PDF Listen +++ +++ Population ++ –Adults, adolescents, and pregnant women. +++ Recommendation ++ USPSTF 2008 ++ –Insufficient evidence to recommend for or against routine screening for illicit drug use. ++ Source ++ –USPSTF. Drug Use, Illicit: Screening. 2008. + TOBACCO USE Download Section PDF Listen +++ +++ Population ++ –Adults including pregnant women. +++ Recommendation ++ AAFP 2015, USPSTF 2015 ++ –Recommend screening all adults for tobacco use and provide tobacco cessation interventions for those who use tobacco products. ++ Source ++ –USPSTF. Tobacco Smoking Cessation in Adults, Including Pregnant Women: Behavioral and Pharmacotherapy Interventions. 2015. +++ Comment ++ Provide some type of SBIRT (Screening, Brief Intervention, and Referral to Treatment) such as: The “5-A” framework is helpful for smoking cessation counseling: Ask about tobacco use. Advise to quit through clear, individualized messages. Assess willingness to quit. Assist in quitting. Arrange follow-up and support sessions. +++ Population ++ –School-aged children and adolescents. +++ Recommendation ++ USPSTF 2013 ++ –Recommends that primary care clinicians provide interventions including education or brief counseling to prevent the initiation of tobacco use. +++ Comment ++ The efficacy of counseling to prevent tobacco use in children and adolescents is uncertain. ++ Source ++ –USPSTF. Tobacco Use in Children and Adolescents: Primary Care Interventions. 2013.