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 Chapter 6.

This issue of Primary Care: Clinics in Office Practice, edited by Mack T. Ruffin IV, MD, MPH and Cameron G. Shultz PhD, MSW, is devoted to Preventive Medicine. Articles in this issue include Risk Assessment Approach Screening; Substance Use and Tobacco Screening; Sexually Transmitted Infections; Planned Pregnancy; Violence Screening; Breast Cancer Screening; Lung Cancer Screening; Colorectal Cancer Screening; Prostate Cancer Screening; Heart Disease Screening; Screening for Depression; and Use of Genetic Markers.

Clinical supervision (CS) is emerging as the crucible in which counselors acquire knowledge and skills for the substance abuse (SA) treatment profession, providing a bridge between the classroom and the clinic. Supervision is necessary in the SA treatment field to improve client care, develop the professionalism of clinical personnel, and maintain ethical standards. Contents of this report: (1) CS and Prof¿l. Develop. of the SA Counselor: Basic info. about CS in the SA treatment field; Presents the ¿how to¿ of CS.; (2) An Implementation Guide for Admin.; Will help admin. understand the benefits and rationale behind providing CS for their program¿s SA counselors. Provides tools for making the tasks assoc. with implementing a CS system easier. Illustrations.

This TIP provides counselors with clinical guidelines to assist with problems that routinely occur with clients in the criminal justice system who are dealing with substance abuse and dependency disorders. It describes the unique needs of offenders. It addresses the challenges counselors and criminal justice personnel are likely to face at every stage of the criminal justice continuum.

This Treatment Improvement Protocol (TIP)is a companion to TIP 51, Substance Abuse Treatment: Addressing the Specific Needs of Women. These two volumes look at how gender-specific treatment strategies can improve outcomes for men and women, respectively.The physical, psychological, social, and spiritual effects of substance use and abuse on men can be quite different from the effects on women, and those differences have implications for treatment in behavioral health settings. Men are also affected by social and cultural forces in different ways than women, and physical differences between the genders influence substance use and recovery as well.This TIP, Addressing the Specific Behavioral Health Needs of Men, addresses these distinctions. It provides practical information based on available evidence and clinical experience that can help counselors more effectively treatment with substance use disorders

Part 1 of this Protocol is for substance abuse counselors and consists of two chapters. Chap. 1 presents the ¿what¿ and ¿why¿ of working with clients with substance use disorders who have depressive symptoms. Chap. 2 presents the ¿how to¿ of working with clients with depressive symptoms. Part 2 is an implementation guide for program administrators and consists of two chapters. Chap. 1 lays out the rationale for the approach taken in Chap. 2 and will help you understand the processes of organizational change and the factors that can facilitate or impede such change. Chap. 2 provides detailed info. on how to achieve high-quality implementation of the recommendations in Part 1 of this report. Illustrations.

This issue of Primary Care: Clinics in Office Practice, guest edited by Dr. Janet Albers, is devoted to Psychiatric Care in Primary Care Practice. Articles in this issue include: Integrating Behavioral Health in the Medical Home Model – The Role of the Interdisciplinary Team; Behavioral Health in Prevention and Chronic Illness Management – Motivational Interviewing; Childhood Sexual Abuse and Mental Health Screening in Primary Care; Autism Spectrum/Pervasive Developmental Disorders; Pearls in Working with Patients Diagnosed with Personality Disorders; Psychopharmacology in Primary Care Settings; Depression: Screening, Diagnosis, Treatment Across Populations; Anxiety Disorders in Primary Care; Bipolar Disorder; Eating Disorders; Substance Abuse Screening and Treatment; Pain Medication Seeking Behavior; Psychiatric Emergencies; and Physician Wellness Across the Professional Continuum.

Many health problems that healthcare practitioners encounter derive from or are complicated by alcohol use disorders (AUD). Four approved medications that treat AUD make treatment in primary care a viable adjunct or alternative to specialty care, with many potential advantages. Screening for and providing brief interventions to treat AUD in general medical settings promote healthy life choices and increase the likelihood of recovery, especially for patients who have not yet progressed to chronic alcohol dependence, those with comorbid medical disorders being treated in these settings, and those who otherwise would not seek or receive treatment for their AUD. This report provides a resource to assist the health-care provider in this effort. Illus.

This book is written for any clinician who encounters substance abuse in a patient and wonders what to do. Experts from a cross-section of specialties and health professions provide up-to-date, evidence-based guidance on how non-expert clinicians can recognize, understand, and approach the management of substance abuse in their patients. They detail the range of treatments available and whether and how they work. The central importance of using a carefully selected multimodal approach that is tailored to the individual patient is emphasized throughout and illustrated in case scenarios from actual clinical practice.