Behavioral Health, An Issue of Primary Care: Clinics in Office Practice, E-Book (eBook)

Behavioral Health, An Issue of Primary Care: Clinics in Office Practice, E-Book

Meagan Vermeulen (Herausgeber)

eBook Download: EPUB

2023 | 1. Auflage
240 Seiten
Elsevier Health Sciences (Verlag)
978-0-323-93944-7 (ISBN)

Infos

In this issue, guest editors bring their considerable expertise to this important topic.
Provides in-depth reviews on the latest updates in the field, providing actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize

Textauszug

Motivational Interviewing in Primary-Care

Substance Use Disorders beyond AUDIT/DAST

Joanna Petrides, MBS, PsyD a , b email address: [e-mail]       aDepartment of Family Medicine, Rowan-Virtua School of Osteopathic Medicine, 42 East Laurel Road, Suite 2100A, Stratford, NJ 08084, USA      bDepartment of Psychology, Rowan-Virtua School of Osteopathic Medicine, 42 East Laurel Road, Suite 2100A, Stratford, NJ 08084, USA

Primary-care settings have a unique advantage to reaching a broad range of the population and the ability to address a wide array of presenting problems, including substance-use. With high rates of substance-use in the United States and low rates of substance-use treatment utilization, the primary-care office is key in assessing and supporting patients in changing substance-use behaviors. Motivational interviewing is a conversational tool physicians can use to highlight intrinsic motivation for change and support specific changes patients want to make. Providers can also apply motivational interviewing to a variety of chronic health care behaviors.

Keywords

Motivational interviewing; Substance-use; Primary-care; Mental health

Key points

1. • Primary-care physicians have a distinct opportunity to provide counseling regarding substance-use behaviors and to support patients in making behavioral changes.
2. • Motivational interviewing is a conversational style physicians can use to facilitate and support patients’ desire for making behavioral changes.
3. • The spirit of motivational interviewing includes establishing a collaborative partnership between the patient and provider, evoking from patients what they care about as a conduit toward change, and honoring the patient’s autonomy in decision making.
4. • The OARS approach is one interaction technique physicians can use in motivational interviewing and it includes the use of open-ended questions, affirmations, reflective listening, and summaries.
5. • Physicians should avoid engaging in certain traps when speaking with patients about creating behavioral changes such as arguing with resistance and the expert, labeling, and question–answer traps.

Substance-use disorders in the primary-care setting

Prevalence of Substance-Use Disorders

Results from the 2020 National Survey on Drug Use and Health show 58.7% of people age 12 or older reported using substances including tobacco, alcohol, and illicit drugs within the past month, 1 with this rate likely higher in subsequent years as a result of the coronavirus disease-2019 (COVID-19) pandemic effects. Among the illicit substances, the most commonly used was marijuana, followed by stimulants (cocaine, methamphetamine, and prescription stimulants), opioids (heroin or prescription pain relievers), non-opioid prescription pain relievers, and hallucinogens. 1

Unfortunately, of those individuals age 12 or older needing substance-use treatment, only 1.4% received any kind of treatment in 2020. 1 The lack of engagement in substance-use treatment can be attributed to the limited access to specialized substance-use treatment programs and limitations brought on by the COVID-19 pandemic, among other reasons. Untreated and escalating patient substance-use behaviors not only affect the individual and their families, but also drive up the cost of health care. 2 With access to specialized substance-use treatment being limited, primary-care settings become a key site for addressing substance-use behaviors with patients, preventing substance-use from progressing into more problematic levels, and facilitating change in substance-use behaviors.

Use of Pre-Screening/Screening Tools in Primary-Care Settings

Addressing substance-use disorders has long been an element of patient care in the primary-care setting given that primary-care providers have established long-term relationships with their patients based on trust, and primary-care is considered a “gateway” to other specialties, often making it the patient’s first stop in treating any chronic condition. A recent study confirmed screenings for substance-use in primary-care settings helped identify patients with problematic substance-use behaviors and those with multiple substance-use disorders. 3 Furthermore, awareness of patient substance-use in primary-care also assists in the effective treatment planning for problematic substance-use and other chronic conditions. 3

The US Preventive Services Task Force (USPSTF) recommends screening all adults age 18 or older for unhealthy drug use by asking them questions about use and that screening should be conducted when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred. 4 The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends the use of screening, brief intervention and referral to treatment (SBIRT) to assess severity of use and determine appropriate level of intervention. 5 SBIRT can be easily implemented into primary-care, emergency, and community settings to provide a comprehensive approach to screening and early intervention. 5 Screening is done with validated screening measures that show the severity of a patient’s use. The most commonly used screening measures are the Alcohol-use Disorders Identification Test (AUDIT) for alcohol-use and the Drug Abuse Screen Test (DAST-10) for other substance-use. 6 Both measures are self-administered in the office setting, and reviewed and discussed with the health care provider. Screening for alcohol and substance-use are not limited to these measures and providers should use the screener that best fits their practice and patient needs.

Despite the effective implementation and use of screening tools in primary-care settings to identify the presence of substance-use problems, follow-up on addressing these problems has remained low, with lower follow-up rates occurring in rural areas. 7 A likely factor for this deficiency could be due to primary-care providers’ limited understanding of approaches for and discomfort with engaging patients in conversations about substance-use practices. Beyond screening and providing patients with medical guidelines on recommended substance-use patterns for their health, many providers feel at a loss for how to engage their patients in discussing substance-use behavior and how to support them toward making a self-directed change. Motivational interviewing is a tool that provides physicians with a guide for having these difficult conversations successfully.

Implementing motivational interviewing for substance-use into primary-care

Development of Motivational Interviewing

Motivational interviewing is a conversational style used toward fostering effective behavioral changes across a wide range of health behaviors. 8 , 9 Motivational interviewing was first developed in 1983 as a brief intervention for problematic alcohol-use and focused on addressing low levels of motivation as an obstacle to change. 8 , 9 Motivational interviewing has since been used and found effective with other health problems and chronic diseases in particular. 8 , 9 The mechanism of action for motivational interviewing is to elicit a patient’s intrinsic motivation for making a behavioral change and adhere to treatment. 8 , 9

Application of Motivational Interviewing

Conversations about changing behaviors develop organically and occur frequently in the primary-care setting, making it the ideal location for motivational interviewing to be incorporated. Motivational interviewing is a patient-centered approach focused on establishing a collaborative partnership between the patient and provider, evoking from the patient what they care about as a conduit toward change, and honoring the patient’s autonomy in decision making. 8 This is knowns as the “spirit” of motivational interviewing. 8 Using this approach places the provider in a position of being a guide through change for patients by helping them develop an intrinsic motivation to change versus deciding the change path for the patient, which is typically ineffective. 10

Using Motivational Interviewing to Move Change Along

Engaging in the process of developing change is a challenging undertaking for many people and this is especially true when making changes in substance-use behaviors. Patients with problematic substance-use behaviors often struggle with the ambivalence about making changes which is a factor in the continued use of substances. These patients can often be viewed as stuck, resistant, or unmotivated which leads providers to believe patients do not want to make changes. 9 Through the use of motivational interviewing, providers can identify this ambivalence to change and help transition it to meaningful action by using the patient’s own motivating factors. It is important for the physician to be present in a nonjudgmental and open manner toward the patient to convey their support for the patient’s process of making change. Some specific motivational interviewing techniques and approaches that are applicable in a primary-care setting will be discussed below.

RULE

Health care providers have a natural instinct...

Produkt-Details

• Erscheint lt. Verlag: 27.2.2023
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Allgemeines / Lexika
• Themenwelt: Medizin / Pharmazie ► Gesundheitswesen
• Themenwelt: Studium ► Querschnittsbereiche ► Infektiologie / Immunologie
• ISBN-10: 0-323-93944-9 / 0323939449
• ISBN-13: 978-0-323-93944-7 / 9780323939447