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Chapter 1: Behavioral Health and Substance Use Disorders

ALCOHOL USE DISORDERS

Population

Adults without known alcohol use disorder.

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.

Practice Pearls

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

  • 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

Population

Adults without a diagnosis or signs of 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.

Practice Pearls

  • To diagnose depression, follow a positive PHQ-2 with a PHQ-9 or similar instrument.

  • 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

Population

Adults without known drug use.

Organization

► USPSTF 2020

Screening Recommendation

  • – Screen and implement a treatment care plan.

Practice Pearl

Source

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

INTIMATE PARTNER VIOLENCE

Population

Women of reproductive age.

Organization

► USPSTF 2018

Screening Recommendations

  • – Screen all women of reproductive age for intimate partner violence.

  • – If positive, offer ongoing support services.

Practice Pearl

  • The HARK, HITS/E-HITS, PVS, and WAST are validated screening tools.

Source

  • – USPSTF. JAMA. 2018;320(16):1678-1687.

TOBACCO USE

Population

Adults without known tobacco use.

Organizations

► AAFP 2015, USPSTF 2015, NICE 2021

Screening Recommendations

  • – Screen all adults for tobacco ...

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