Interesting articles

Dear Friends and Colleagues:
By reviewing several journals I found the attached articles which may help you to manage patients in your office:

1) Realistic Approaches to Counseling in the Office Setting,
H. RUSSELL SEARIGHT, PhD, MPH, Department of Psychology, Lake Superior State University, Sault Sainte Marie, Michigan
Although it is often unrecognized, family physicians provide a significant amount of mental health care in the United States. Time is one of the major obstacles to providing counseling in primary care. Counseling approaches developed specifically for ambulatory patients and traditional psychotherapies modified for primary care are efficient first-line treatments. For some clinical conditions, providing individualized feedback alone leads to improvement. The five A's (ask, advise, assess, assist, arrange) and FRAMES (feedback about personal risk, responsibility of patient, advice to change, menu of strategies, empathetic style, promote self-efficacy) techniques are stepwise protocols that are effective for smoking cessation and reducing excessive alcohol consumption. These models can be adapted to address other problems, such as treatment nonadherence. Although both approaches are helpful to patients who are ready to change, they are less likely to be successful in patients who are ambivalent or who have broader psychosocial problems. For patients who are less committed to changing health risk behavior or increasing healthy behavior, the stages-of-change approach and motivational interviewing address barriers. Patients with psychiatric conditions and acute psychosocial stressors will likely respond to problem-solving therapy or the BATHE (background, affect, troubles, handling, empathy) technique. Although brief primary care counseling has been effective, patients who do not fully respond to the initial intervention should receive multimodal therapy or be referred to a mental health professional. (Am Fam Physician. 2009;79(4):277-284. Copyright © 2009 American Academy of Family Physicians.)
http://www.aafp.org/afp/20090215/277.html

2) Reducing Tobacco Use in Adolescents
IRENE M. ROSEN, LTC, MC, USA, Madigan Army Medical Center, Fort Lewis, Washington
DOUGLAS M. MAURER, MAJ, MC, USA, Carl R. Darnall Army Medical Center, Fort Hood, Texas
After steadily decreasing since the late 1990s, adolescent smoking rates have stabilized at levels well above national goals. Experts recommend screening for tobacco use and exposure at every patient visit, although evidence of improved outcomes in adolescents is lacking. Counseling should be provided using the 5-A method (ask, advise, assess, assist, and arrange). All smokers should be offered smoking cessation assistance, including counseling, nicotine replacement therapy, bupropion therapy, or combination therapy. Pharmacotherapy of any kind doubles the likelihood of successful smoking cessation in adults; however, nicotine replacement therapy is the only pharmacologic intervention that has been extensively studied in children. Community interventions such as smoking bans and educational programs have been effective at reducing smoking rates in children and adolescents. Antismoking advertising and tobacco sales taxes also help deter new smokers and motivate current smokers to attempt to quit. (Am Fam Physician. 2008;77(4):483-490, 491-492. Copyright © 2008 American Academy of Family Physicians.)
http://www.aafp.org/afp/20080215/483.html

3) Adolescent Substance Use and Abuse: Recognition and Management
KIM S. GRISWOLD, MD, MPH; HELEN ARONOFF, MD, MAT; JOAN B. KERNAN, BS; and LINDA S. KAHN, PhD State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York
Substance abuse in adolescents is undertreated in the United States. Family physicians are well positioned to recognize substance use in their patients and to take steps to address the issue before use escalates. Comorbid mental disorders among adolescents with substance abuse include depression, anxiety, conduct disorder, and attention-deficit/hyperactivity disorder. Office-, home-, and school-based drug testing is not routinely recommended. Screening tools for adolescent substance abuse include the CRAFFT questionnaire. Family therapy is crucial in the management of adolescent substance use disorders. Although family physicians may be able to treat adolescents with substance use disorders in the office setting, it is often necessary and prudent to refer patients to one or more appropriate consultants who specialize specifically in substance use disorders, psychology, or psychiatry. Treatment options include anticipatory guidance, brief therapeutic counseling, school-based drug-counseling programs, outpatient substance abuse clinics, day treatment programs, and inpatient and residential programs. Working within community and family contexts, family physicians can activate and oversee the system of professionals and treatment components necessary for optimal management of substance misuse in adolescents. (Am Fam Physician. 2008;77(3):331-336. Copyright © 2008 American Academy of Family Physicians.)
http://www.aafp.org/afp/20080201/331.html

I look forward to your feedback.
Yours
Bernd Wollschlaeger,MD,FAAFP,FASAM
President, Florida Society of Addiction Medicine