Chapter 1: Behavioral Health and Substance Use Disorders

ALCOHOL USE DISORDERS

Organizations

• ► CDC 2018, USPSTF 2018

Screening Recommendations

• – Screen all adults in primary care settings for alcohol misuse, including pregnant people.

• – If positive, administer a brief behavioral counseling intervention and offer or refer for diagnostic assessment.

Comments

1. Screen regularly using a validated tool such as the AUDIT, CAGE, or MAST questionnaires.

2. The TWEAK, T-ACE, and 4P’s Plus are designed to screen pregnant people for alcohol misuse.

Sources

• – CDC. Alcohol Screening and Brief Intervention for People Who Consume Alcohol and Use Opioids. 2018.

• – USPSTF. JAMA. 2018;320(18):1899-1909.

• – ASAM. Public Policy Statement on Screening for Addiction in Primary Care Settings. 1997.

DEPRESSION

Organization

• ▸ USPSTF 2016

Screening Recommendations

• – Screen adults for depression, including pregnant and postpartum women.

• – If positive, confirm diagnosis, offer effective treatment, and ensure appropriate follow-up.

Comments

1. A positive PHQ-2 should be followed by a PHQ-9 or a similar instrument, to diagnose depression.

2. Optimal screening interval is unknown. AAP recommends screening mothers for postpartum depression at the infant’s 1-, 2-, 4-, and 6-mo visits.

Source

• – USPSTF. JAMA. 2016;315(4):380-387.

ILLICIT DRUG USE

Organization

• ▸USPSTF 2020

Screening Recommendation

• – Screen and implement a treatment care plan.

Comment

1. The NIH hosts a collection of screening tools at https://nida.nih.gov/nidamed-medical-health-professionals/screening-tools-resources/chart-screening-tools

Source

• – USPSTF. JAMA. 2020;323(22):2301-2309.

TOBACCO USE

Organization

• ▸ AAFP 2015, USPSTF 2015

Screening Recommendations

• – Screen all adults for tobacco use.

• – Provide tobacco cessation interventions for those who use tobacco products.

Comment

1. Provide some type of SBIRT (Screening, Brief Intervention, and Referral to Treatment) such as:

   1. The “5-A” framework is helpful for smoking cessation counseling:

      1. Ask about tobacco use.

      2. Advise to quit through clear, individualized messages.

      3. Assess willingness to quit.

      4. Assist in quitting.

      5. Arrange follow-up and support sessions.

Source

• – USPSTF. JAMA. 2021;325(3):265-279.