+++
ALCOHOL ABUSE AND DEPENDENCE
++
++
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.
++
++
–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.
++
Screen regularly using a validated tool such as the AUDIT, CAGE, or MAST questionnaires.
The TWEAK and the T-ACE are designed to screen pregnant women for alcohol misuse.
++
++
++
++
++
++
Screen using a tool designed for adolescents, such as the CRAFFT, BSTAD, or S2BI.
Reinforce not drinking and driving or riding with any driver under the influence.
Reinforce to women the harmful effects of alcohol on fetuses.
++
++
++
++
++
++
++
++
++
++
++
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.
Treatment options include pharmacotherapy (fluoxetine and escitalopram have FDA approval for this age group), psychotherapy, collaborative care, psychosocial support interventions, and CAM approaches.
SSRI may increase suicidality in some adolescents, emphasizing the need for close follow-up.
++