6: Integrating Opioid Use Disorder Treatment in Clinical Care
This module discusses the importance of integrating opioid use disorder (OUD) pharmacotherapy into general medical settings, describes models in primary care, emergency rooms, and hospitals where medications for OUD treatment are successfully included as standard care, and reviews keys to OUD pharmacotherapy implementation in clinical practice. Participants are encouraged to adapt this information for use in their own clinical practices.
7: Treatment of Tobacco Use Disorder in Primary Care
Tobacco use disorder is still a major cause of preventable death. Populations with low income, lower education and/or behavioral health comorbidity (mental illness or SUD) use tobacco at higher rates. Even brief interventions can be effective and should be provided routinely in health care settings. Counseling and medications are both considered first-line treatments and outcomes are better if they are provided together. Assessment of the time to first cigarette use in the morning is a good indicator of level of addiction to tobacco. Tobacco withdrawal causes clinically significant symptoms of agitation, anxiety, restlessness, and impaired concentration that can undermine success in quitting. Medications are effective in reducing these withdrawal symptoms and at least doubling the smoker’s chance of success in quitting. These medications include nicotine replacement, bupropion and varenicline. These are generally well tolerated and safer than the ongoing use of tobacco. Varenicline or combination NRT can be considered first line treatments since they are associated with greater success in quitting than other treatments. Use of medications is also associated with reductions in tobacco use that can lead to future quit attempts. This educational activity will review updates in evidence-based treatments for tobacco use disorder.
15: Managing Common Psychiatric Conditions in Primary Care
Co-occurring psychiatric conditions are frequently seen in patients with substance use disorders. Clinicians should be alert to the signs and symptoms of common psychiatric disorders and should understand how to distinguish independent psychiatric disorders from substance-induced disorders. Depressive disorders and anxiety disorders, including post-traumatic stress disorder, are the most common co-occurring conditions, though ADHD is often encountered across the range of substance use disorders. Substance use disorder patients with co-occurring psychiatric disorders will respond to most standard psychological and pharmacological treatments for these psychiatric conditions, though clinicians should avoid the use of scheduled medications and must always focus on sobriety as a primary treatment goal. Treatment that integrates addiction and psychiatric care is the most effective.
17: Nicotine and Stimulant Use in Adolescents
This module reviews recent trends in nicotine and stimulant use in adolescents in young adults. It also presents a summary of the neurobiology of nicotine, discusses the different health effects and risks of harm of nicotine and stimulants (including illicit stimulants, prescription stimulants and caffeine) and offers an overview of prevention and treatment strategies for youth.
Talking with Your Adult Patients about Alcohol, Drug, and/or Mental Health Problems
This guide provides clinicians with questions to begin discussions with adult patients about mental illness, substance use disorders, or both. It includes resources for patients who need an evaluation after a positive screening.
Collaborative Care for Substance Use Disorders
The collaborative care model is designed to increase access to mental health care by treating common conditions in primary care settings, which are often the front lines for diagnosing depression, anxiety, and PTSD. In light of the growing demand for treatment of substance use disorders, we explore the potential impact of the collaborative care model, since substance use disorders are also often first identified in a primary care setting.
