TY - JOUR
KW - Directive Counseling
KW - Domestic Violence/psychology
KW - Female
KW - Humans
KW - Male
KW - Opiate Substitution Treatment
KW - Primary Health Care/methods
KW - Substance-Related Disorders/diagnosis/psychology/therapy
AU - B. Shapiro
AU - D. Coffa
AU - E. F. McCance-Katz
A1 - 
AB - Substance misuse is common among patients in primary care settings. Although it has a substantial health impact, physicians report low levels of preparedness to identify and assist patients with substance use disorders. An effective approach to office-based treatment includes a coherent framework for identifying and managing substance use disorders and specific strategies to promote behavior change. Brief validated screening tools allow rapid and efficient identification of problematic drug use, including prescription medication misuse. After a positive screening, a brief assessment should be performed to stratify patients into three categories: hazardous use, substance abuse, or substance dependence. Patients with hazardous use benefit from brief counseling by a physician. For patients with substance abuse, brief counseling is also indicated, with the addition of more intensive ongoing follow-up and reevaluation. In patients with substance dependence, best practices include a combination of counseling, referral to specialty treatment, and pharmacotherapy (e.g., drug tapering, naltrexone, buprenorphine, methadone). Comorbid mental illness and intimate partner violence are common in patients with substance use disorders. The use of a motivational rather than a confrontational communication style during screening, counseling, and treatment is important to improve patient outcomes.
BT - American Family Physician
C5 - Opioids & Substance Use
CP - 2
CY - United States
IS - 2
JF - American Family Physician
N2 - Substance misuse is common among patients in primary care settings. Although it has a substantial health impact, physicians report low levels of preparedness to identify and assist patients with substance use disorders. An effective approach to office-based treatment includes a coherent framework for identifying and managing substance use disorders and specific strategies to promote behavior change. Brief validated screening tools allow rapid and efficient identification of problematic drug use, including prescription medication misuse. After a positive screening, a brief assessment should be performed to stratify patients into three categories: hazardous use, substance abuse, or substance dependence. Patients with hazardous use benefit from brief counseling by a physician. For patients with substance abuse, brief counseling is also indicated, with the addition of more intensive ongoing follow-up and reevaluation. In patients with substance dependence, best practices include a combination of counseling, referral to specialty treatment, and pharmacotherapy (e.g., drug tapering, naltrexone, buprenorphine, methadone). Comorbid mental illness and intimate partner violence are common in patients with substance use disorders. The use of a motivational rather than a confrontational communication style during screening, counseling, and treatment is important to improve patient outcomes.
PP - United States
PY - 2013
SN - 1532-0650; 0002-838X
SP - 113
EP - 121
EP - 
T1 - A primary care approach to substance misuse
T2 - American Family Physician
TI - A primary care approach to substance misuse
U1 - Opioids & Substance Use
U2 - 23939642
VL - 88
VO - 1532-0650; 0002-838X
Y1 - 2013
ER -