Chapter 1: Behavioral Health Disorders

ALCOHOL ABUSE AND DEPENDENCE

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

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

2. 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

1. Screen using a tool designed for adolescents, such as the CRAFFT, BSTAD, or S2BI.

2. Reinforce not drinking and driving or riding with any driver under the influence.

3. Reinforce to women the harmful effects of alcohol on fetuses.

DEPRESSION

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

1. 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.

2. Treatment options include pharmacotherapy (fluoxetine and escitalopram have FDA approval for this age group), psychotherapy, collaborative care, psychosocial support interventions, and CAM approaches.

3. SSRI may increase suicidality in some adolescents, emphasizing the need for close follow-up.

Population

• –Adults.