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A Guide to Substance Abuse Services for Primary Care Clinicians.


Center for Substance Abuse Treatment.


Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1997. Report No.: (SMA) 97-3139.
SAMHSA/CSAT Treatment Improvement Protocols.


The objective of this TIP, A Guide to Substance Abuse Services for Primary Care Clinicians, is to help physicians, nurses, physician assistants, and advanced practice nurses (nurse practitioners and clinical nurse specialists) screen their patients for substance use disorders, conduct brief interventions for patients in the early stages of problem development, and appropriately refer more severely affected patients for in-depth assessment and treatment. The TIP also gives an overview of the types of treatment available and outlines a primary care clinician's role in aftercare. This document gives primary care clinicians specific guidance on identifying indications of substance abuse, how to broach the subject with a patient, and what screening and assessment instruments to use. It explains how to perform an office-based brief intervention in which patient and clinician set mutually agreed upon goals and "contract" to stop or cut back the alcohol or other drug use. The elements of in-depth assessments, appropriate referrals, and specialized treatment are discussed. The appendixes to the document include discussions by experts on leading pharmacotherapies for alcohol and other drugs and legal issues of patient confidentiality. This TIP equips primary care clinicians who may not have any knowledge of the substance abuse field to address this pervasive disease. The physicians, nurses, social workers, researchers, certified alcohol counselors, program directors, and pharmacologists on the Consensus Panel pooled years of research and practice to devise recommendations that can be readily implemented in a busy primary care setting. This TIP represents another step by CSAT toward its goal of bringing national leadership to bear in the effort to improve substance abuse treatment.

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