Your session will expire automatically in 0 seconds.
LEADER 00000cam a2200457Ma 4500
006 m o d
007 cr |n|||||||||
008 981118s1997 mdua obt f000 0 eng d
060 00 W1|bTR33LG v.24 1997
060 10 WM 270
082 00 616.86|221
100 1 Sullivan, Eleanor J.,|d1938-
245 12 A guide to substance abuse services for primary care
clinicians /|cEleanor Sullivan, Michael Fleming.
260 Rockville, MD :|bU.S. Dept. of Health and Human Services,
Public Health Service, Substance Abuse and Mental Health
Services Administration, Center for Substance Abuse
300 1 online resource (xvii, 168 pages) :|billustrations.
338 online resource|bcr|2rdacarrier
490 1 Treatment improvement protocol (TIP) series ;|v24
490 1 DHHS Publication ;|vno. (SMA) 97-3139
500 PHS contract no. ADM 270-95-0013.
504 Includes bibliographical references.
520 3 EXECUTIVE SUMMARY AND RECOMMENDATIONS: The goal of this
TIP is to recommend guidelines for primary care clinicians
to follow in caring for patients with alcohol and other
drug use disorders. These guidelines were developed by a
Consensus Panel of clinicians, researchers, and educators
who work on the prevention and treatment of substance use
disorders. Protocols are based partly on research evidence,
partly on Panel members' clinical experience. The
algorithm to the left follows a patient with substance use
problems who presents in a primary care setting. The chart
will serve as a guide or road map through screening, brief
assessment, brief intervention, assessment, referral,
specialized treatment, and followup care as they are
detailed in the TIP. Since substance use disorders are
often chronic conditions that progress slowly over time,
primary care clinicians, through their regular, long-term
contact with patients, are in an ideal position to screen
for alcohol and drug problems and monitor each patient's
status. Futhermore, studies have found that primary care
clinicians can actually help many patients decrease
alcohol consumption and its harmful consequences through
office-based interventions that take only 10 to 15 minutes
(Kahan et al., 1995; Wallace et al., 1988). This potential,
however, is largely untapped: Saitz and colleagues found
that of a sample of patients seeking substance abuse
treatment, 45 percent reported that their primary care
physician was unaware of their substance abuse (Saitz et
al., in press). Yet even though screening and limited
treatment of substance use disorders do not require a
large time investment, the Consensus Panel that developed
this TIP recognized that many primary care clinicians are
already overwhelmed by the demands imposed by expanded
gatekeeper functions. The Panel realized that a practical
approach to addressing patients' substance abuse problems
was needed: one that recognized the time and resource
limitations inherent in primary care practice and offered
a series of graduates approaches that could be
incorporated into a normal clinic or office routine.
Biological, medical, and genetic factors as well as
psychological, social, familial, cultural, and other
environmental features all bear on substance abuse.
Addressing the condition effectively requires a team
effort, especially when it has progressed beyond the early
stage. For this reason, in addition to screening and
intervention treatment options, these guidelines include
information about viable referral for assessment and
treatment, as well as followup. Readers will notice that
the TIP contains more information on alcohol use and abuse
than on use of illicit drugs. This reflects both the scope
of the problems and the research literature available
about them. It is estimated that about 18 million people
with alcohol use problems and 5 million users of illicit
drugs need treatment. Although the Panel recognizes that
tobacco is an addictive substance with a major public
health impact, it is not included in this TIP because the
topic falls outside CSAT's purview. Readers are referred
to "Smoking Cessation: a Guide for Primary Care Clinicians,
" published by the Agency for Health Care Policy and
Research (Agency for Health Care Policy and Research,
1996). The Consensus Panel's recommendations are based on
a combination of clinical experience and research-based
evidence. In the list below, the summary guidelines
supported by the research literature are followed by (1);
clinically based recommendations are marked (2). Citations
supporting the former are referenced in the body of the
document. Screening and assessment instruments mentioned
below are reproduced and discussed in Chapters 2 and 4 and
Appendix C. The guidelines are presented in more detail in
650 0 Substance abuse.
650 0 Primary care (Medicine)
655 2 Practice Guideline.
655 2 Technical Report.
700 1 Fleming, Michael F.,|d1948-
710 2 Center for Substance Abuse Treatment (U.S.)
710 2 National Library of Medicine|eissuing body.
830 0 Treatment improvement protocol (TIP) series ;|vno. 24.
830 0 DHHS publication ;|vno. (SMA) 97-3139.
830 0 NCBI BookShelf
856 40 |uhttp://www.ncbi.nlm.nih.gov/books/NBK64827|zConnect to
ebook (University of Melbourne only)
990 National Center for Biotechnology Information
990 Batch Ebook load (bud2) - do not edit, delete or attach
991 |zNEW New collection NLM.bookshelf 2018-08-03